Treatment of amyloidogenic diseases

ABSTRACT

The invention provides preferred dosage ranges, maximum concentrations, average concentrations and monitoring regimes for use in treatment of Alzheimer&#39;s disease using antibodies to Aβ. The invention also provides monitoring regimes that can assess changes in symptoms or signs of the patient following treatment.

BACKGROUND OF THE INVENTION

Alzheimer's disease (AD) is a progressive disease resulting in seniledementia. See generally Selkoe, TINS 16:403 (1993); Hardy et al., WO92/13069; Selkoe, J. Neuropathol. Exp. Neurol. 53:438 (1994); Duff etal., Nature 373:476 (1995); Games et al., Nature 373:523 (1995). Broadlyspeaking, the disease falls into two categories: late onset, whichoccurs in old age (65+ years) and early onset, which develops wellbefore the senile period, i.e., between 35 and 60 years. In both typesof disease, the pathology is the same but the abnormalities tend to bemore severe and widespread in cases beginning at an earlier age. Thedisease is characterized by at least two types of lesions in the brain,neurofibrillary tangles and senile plaques. Neurofibrillary tangles areintracellular deposits of microtubule associated tau protein consistingof two filaments twisted about each other in pairs. Senile plaques(i.e., amyloid plaques) are areas of disorganized neuropil up to 150 μmacross with extracellular amyloid deposits at the center which arevisible by microscopic analysis of sections of brain tissue. Theaccumulation of amyloid plaques within the brain is also associated withDown's syndrome and other cognitive disorders.

The principal constituent of the plaques is a peptide termed Aβ orβ-amyloid peptide. Aβ peptide is a 4-kDa internal fragment of 39-43amino acids of a larger transmembrane glycoprotein named protein termedamyloid precursor protein (APP). As a result of proteolytic processingof APP by different secretase enzymes, Aβ is primarily found in both ashort form, 40 amino acids in length, and a long form, ranging from42-43 amino acids in length. Part of the hydrophobic transmembranedomain of APP is found at the carboxy end of Aβ, and may account for theability of Aβ to aggregate into plaques, particularly in the case of thelong form. Accumulation of amyloid plaques in the brain eventually leadsto neuronal cell death. The physical symptoms associated with this typeof neural deterioration characterize Alzheimer's disease.

Several mutations within the APP protein have been correlated with thepresence of Alzheimer's disease. See, e.g., Goate et al., Nature 349:704(1991) (valine⁷¹⁷ to isoleucine); Chartier Harlan et al. Nature 353:844(1991)) (valine⁷¹⁷ to glycine); Murrell et al., Science 254:97 (1991)(valine⁷¹⁷ to phenylalanine); Mullan et al., Nature Genet. 1:345 (1992)(a double mutation changing lysine⁵⁹⁵-methionine⁵⁹⁶ toasparagine⁵⁹⁵-leucine⁵⁹⁶). Such mutations are thought to causeAlzheimer's disease by increased or altered processing of APP to Aβ,particularly processing of APP to increased amounts of the long form ofAβ (i.e., Aβ1-42 and Aβ1-43). Mutations in other genes, such as thepresenilin genes, PS1 and PS2, are thought indirectly to affectprocessing of APP to generate increased amounts of long form Aβ (seeHardy, TINS 20: 154 (1997)).

Mouse models have been used successfully to determine the significanceof amyloid plaques in Alzheimer's (Games et al., supra, Johnson-Wood etal., Proc. Natl. Acad. Sci. USA 94:1550 (1997)). In particular, whenPDAPP transgenic mice, (which express a mutant form of human APP anddevelop Alzheimer's disease at a young age), are injected with the longform of Aβ, they display both a decrease in the progression ofAlzheimer's and an increase in antibody titers to the Aβ peptide (Schenket al., Nature 400, 173 (1999)). The observations discussed aboveindicate that Aβ, particularly in its long form, is a causative elementin Alzheimer's disease.

McMichael, EP 526,511, proposes administration of homeopathic dosages(less than or equal to 10⁻² mg/day) of Aβ to patients withpreestablished AD. In a typical human with about 5 liters of plasma,even the upper limit of this dosage would be expected to generate aconcentration of no more than 2 pg/ml. The normal concentration of Aβ inhuman plasma is typically in the range of 50-200 pg/ml (Seubert et al.,Nature 359:325 (1992)). Because EP 526,511's proposed dosage wouldbarely alter the level of endogenous circulating Aβ and because EP526,511 does not recommend use of an adjuvant, as an immunostimulant, itseems implausible that any therapeutic benefit would result.

Accordingly, there exists the need for new therapies and reagents forthe treatment of Alzheimer's disease, in particular, therapies andreagents capable of effecting a therapeutic benefit at physiologic(e.g., non-toxic) doses.

CROSS-REFERENCE TO RELATED APPLICATIONS

U.S. Application No. 60/648,631 filed on Jan. 28, 2005; U.S. PublicationNo. US 20060193850 A1 published on Aug. 31, 2006; InternationalPublication No. WO 06/083689 published on Aug. 10, 2006; U.S.Application No. 60/622,525 filed on Oct. 26, 2004 and, U.S. PublicationNo. US 20060160161 A1 published on Jul. 20, 2006 are relatedapplications, all of which are incorporated by herein reference in theirentirety for all purposes.

SUMMARY OF THE INVENTION

The invention provides methods of therapeutically treating Alzheimer'sdisease. The methods comprise administering by intravenous infusion to apatient suffering from the disease a dosage of an antibody within arange of about 0.5 mg/kg to less than 5 mg/kg. The antibody specificallybinds to an N-terminal fragment of beta amyloid peptide (A13) with abinding affinity of at least 10⁷ M⁻¹, and thereby therapeutically treatsthe patient. Optionally, the antibody is a humanized antibody.Optionally, the humanized antibody is a humanized version of mouseantibody 3D6 expressed by the hybridoma deposited under ATCC under No.PTA-5130. Optionally, the humanized antibody comprises (i) a light chaincomprising three complementarity determining regions (CDRs) from theimmunological light chain variable region of the mouse antibody 3D6; and(ii) a heavy chain comprising three complementarity determining regions(CDRs) from the immunological heavy chain variable region of mouseantibody 3D6. Optionally, the humanized antibody comprises (i) avariable light chain region having the sequence as set forth in SEQ IDNO:1, SEQ ID NO:3 or SEQ ID NO:5; and (ii) a variable heavy chain regionhaving the sequence as set forth in SEQ ID NO:2, SEQ ID NO:4 or SEQ IDNO:6. Optionally, the humanized antibody comprises (i) a variable lightchain region having the sequence as set forth in SEQ ID NO:1 or SEQ IDNO:5; and (ii) a variable heavy chain region having the sequence as setforth in SEQ ID NO:2 or SEQ ID NO:6. Optionally, the humanized antibodyis bapineuzumab. Optionally, the antibody is a humanized version ofmouse antibody 10D5 expressed by the hybridoma deposited under ATCCunder No. PTA-5129. Optionally, the humanized antibody comprises (i) alight chain comprising three complementarity determining regions (CDRs)from the immunological light chain variable region of the mouse antibody10D5; and (ii) a heavy chain comprising three complementaritydetermining regions (CDRs) from the immunological heavy chain variableregion of mouse antibody 10D5. Optionally, the humanized antibodycomprises (i) a variable light chain region having the sequence as setforth in SEQ ID NO:7 or SEQ ID NO:28 as set forth in US PatentPublication No. 20050142131; and (ii) a variable heavy chain regionhaving the sequence as set forth in SEQ ID NO:8 or SEQ ID NO:29 as setforth in US Patent Publication No. 20050142131. Optionally, thehumanized antibody is a humanized version of mouse antibody 12A11expressed by the hybridoma deposited under with the American TypeCulture Collection (ATCC), Manassas, Va. 20108, USA on Apr. 8, 2003under the terms of the Budapest Treaty and has deposit number PTA-7271.

Optionally, the humanized antibody comprises (i) a light chaincomprising three complementarity determining regions (CDRs) from theimmunological light chain variable region of the mouse antibody 12A11;and (ii) a heavy chain comprising three complementarity determiningregions (CDRs) from the immunological heavy chain variable region ofmouse antibody 12A11. Optionally, the humanized antibody comprises (i) avariable light chain region having the sequence as set forth in SEQ IDNO:2 as set forth in US Patent Publication No. 20050118651; and (ii) avariable heavy chain region having the sequence as set forth in SEQ IDNO:4 as set forth in US Patent Publication No. 20050118651. In somemethods, the dosage is about 0.5 mg/kg. In some methods, the dosage isabout 1.5 mg/kg. In some methods, the dosage is 0.5 to 3 mg/kg. In somemethods, the dosage is 0.5 to 1.5 mg/kg. In some methods, the dosage isadministered on multiple occasions, such as every 13 weeks.

Some methods further comprise monitoring the patient by at least onetype of assessment selected from the group of consisting of Mini-MentalState Exam (MMSE), Alzheimer's Disease Assessment Scale—cognitive(ADAS-COG), Clinician Interview-Based Impression (CIBI), NeurologicalTest Battery (NTB), Disability Assessment for Dementia (DAD), ClinicalDementia Rating-sum of boxes (CDR-SOB), Neuropsychiatric Inventory(NPI), Positron Emission Tomography (PET Imaging) scan, MagneticResonance Imaging (MRI) scan, and measurement of blood pressure. In somemethods, the type of assessment is an MMSE, and the MMSE is administeredon multiple occasions, such as before administering the dosage, and atweek 4, week 16, 6 months, and 1 year after administering the dosage. Insome methods, the MMSE score measured after administration is higherthan a previously assessed MMSE score.

The invention further provides methods of therapeutically treatingAlzheimer's disease, comprising administering by intravenous infusion toa patient suffering from the disease a dosage of an antibody within arange of about 0.5 mg/kg to less than 5 mg/kg, wherein the antibodyspecifically binds to beta amyloid peptide (Aβ) with a binding affinityof at least 10⁷ M⁻¹, and monitoring the patient for posterior reversibleencephalopathy syndrome (PRES) or vascular edema. Optionally, themonitoring comprises performing an MRI scan, optionally with a FLAIR(Fluid Attenuated Inversion Recovery) sequence imaging. In some methods,the monitoring identifies of at least one clinical symptom associatedwith PRES, such as headache, nausea, vomiting, confusion, seizures,visual abnormalities, altered mental functioning, ataxia, frontalsymptoms, parietal symptoms, stupor, or focal neurological signs. Insome methods, the dosage is reduced or suspended based on an outcome ofthe MRI scan that is indicative of PRES or vascular edema. In somemethods, the dosage is reduced or suspended based on an outcome of theFLAIR sequence imaging that is indicative of PRES or vascular edema. Insome methods, the dosage is reduced or suspended based on anidentification of at least one clinical symptom associated with PRES. Insome methods, the MRI scan is every 3 months, every 6 months, or everyyear. In some methods, the FLAIR sequence imaging is every 3 months,every 6 months, or every year.

Some of the above methods further comprise determining presence orabsence of hypertension in the patient, wherein if the patient hashypertension, the method further comprises administering anantihypertensive. Optionally, the antihypertensive is selected from thegroup consisting of hydroclorothiazide, angiotensin-converting enzyme(ACE) inhibitors, angiotensin II-receptor blockers (ARB), beta blockers,and calcium channel blockers.

Some methods further comprise administering a steroid to the patient totreat the PRES or vascular edema. Optionally, the steroid isdexamethasone or methyprednisolone.

Some methods further comprise reducing or suspending the dosage based onan outcome of the MRI scan and that is indicative of PRES or vascularand identifying at least one clinical symptom associated with PRES orvascular edema, such as headache, nausea, vomiting, confusion, seizures,visual abnormalities, altered mental functioning, ataxia, frontalsymptoms, parietal symptoms, stupor, or focal neurological signs. Somemethods further comprise reducing or suspending the dosage based on anoutcome of the FLAIR sequence imaging that is indicative of PRES orvascular edema and identifying of at least one clinical symptomassociated with PRES or vascular edema, such as headache, nausea,vomiting, confusion, seizures, visual abnormalities, altered mentalfunctioning, ataxia, frontal symptoms, parietal symptoms, stupor, orfocal neurological signs.

In some methods, the monitoring indicates presence of PRES or vascularedema at a first time point after administration, and absence of PRES orvascular edema at a second time point after the first point, and thepatient is administered a first dosage before the monitoring indicatespresence of PRES or vascular edema, a second dosage or no dosage afterthe monitoring detects presence of PRES or vascular edema, and a thirddosage after the monitoring detects absence of PRES or vascular edema,wherein the first and third dosage are higher than the second dosage.

In some of the above methods, the antibody is a humanized antibody.Optionally, the humanized antibody is a humanized version of mouseantibody 3D6 expressed by the hybridoma deposited with the American TypeCulture Collection (ATCC), Manassas, Va. 20108, USA on Apr. 8, 2003under the terms of the Budapest Treaty and has deposit number PTA-5130.

Optionally, the humanized antibody comprises (i) a light chaincomprising three complementarity determining regions (CDRs) from theimmunological light chain variable region of the mouse antibody 3D6; and(ii) a heavy chain comprising three complementarity determining regions(CDRs) from the immunological heavy chain variable region of mouseantibody 3D6. Optionally, the humanized antibody comprises (i) avariable light chain region having the sequence as set forth in SEQ IDNO:1, SEQ ID NO:3 or SEQ ID NO:5; and (ii) a variable heavy chain regionhaving the sequence as set forth in SEQ ID NO:2, SEQ ID NO:4 or SEQ IDNO:6. Optionally, the humanized antibody comprises (i) a variable lightchain region having the sequence as set forth in SEQ ID NO:1 or SEQ IDNO:5; and (ii) a variable heavy chain region having the sequence as setforth in SEQ ID NO:2 or SEQ ID NO:6. Optionally, the humanized antibodyis bapineuzumab.

In some of the above methods, the dosage is about 0.5 mg/kg. In somemethods, the dosage is about 1.5 mg/kg. In some methods, the dosage is0.5 to 3 mg/kg. In some methods, the dosage is 0.5 to 1.5 mg/kg. In somemethods, the dosage is administered on multiple occasions, such as every13 weeks.

In some of the above methods, Bapineuzumab is administered at a firstdosage before PRES or vascular edema is determined from the MRI scan anda second dosage after PRES or vascular edema is determined from the MRIscan, and the second dosage is less then the first dosage. Optionally,the first dosage is 3-5 mg/kg and the second dosage is 0.5 to 3 mg/kg.Optionally, the second dosage is half of the first dosage. Optionally,the Bapineuzumab is administered at a first frequency before the MRIshows PRES or vascular edema and a second frequency after the MRI showsPRES or vascular edema, and the second frequency is less than the firstfrequency.

In some of the above methods, the type of assessment is blood pressure,and the presence or absence of hypertension is determined. Optionally,if the patient has hypertension, the method further comprisesadministering an antihypertensive. Optionally, the antihypertensive isselected from the group consisting of hydroclorothiazide,Angiotensin-converting Enzyme (ACE) Inhibitors, angiotensin II-receptorblockers (ARB), beta blockers, and calcium channel blockers.

The invention further provides therapeutic products. The productscomprise a glass vial and instructions. The glass vial contains aformulation comprising about 10 mg to about 250 mg of a humanized antiAβ antibody, about 4% mannitol or about 150 mM NaCl, about 5 mM to about10 mM histidine, and about 10 mM methionine. The instructions to monitora patient to whom the formulation is administered for PRES and orvascular edema are included with the products.

The invention provides methods method of treating Alzheimer diseasecomprising subcutaneously administering to a patient having the diseasean antibody that specifically binds to an N-terminal fragment of Aβ,wherein the antibody is administered at a dose of 0.01-0.6 mg/kg and afrequency of between weekly and monthly. Optionally, the antibody isadministered at a dose of 0.05-0.5 mg/kg. Optionally, the antibody isadministered at a dose of 0.05-0.25 mg/kg. Optionally, the antibody isadministered at a dose of 0.015-0.2 mg/kg weekly to biweekly.Optionally, the antibody is administered at a dose of 0.05-0.15 mg/kgweekly to biweekly. Optionally, the antibody is administered at a doseof 0.05-0.07 mg/kg weekly. Optionally, the antibody is administered at adose of 0.06 mg/kg weekly. Optionally, the antibody is administered at adose of 0.1 to 0.15 mg/kg biweekly. Optionally, the antibody isadministered at a dose of 0.1 to 0.3 mg/kg monthly. Optionally, theantibody is administered at a dose of 0.2 mg/kg monthly.

The invention provides methods of treating Alzheimer disease comprisingsubcutaneously administering to a patient having the disease an antibodythat specifically binds to an N-terminal fragment of Aβ, wherein theantibody is administered at a dose of 1-40 mg and a frequency of betweenweekly and monthly. Optionally, the antibody is administered at a doseof 5-25 mg. Optionally, the antibody is administered at a dose of 2.5-15mg. Optionally, the antibody is administered at a dose of 1-12 mg weeklyto biweekly. Optionally, the antibody is administered at a dose of2.5-10 mg weekly to biweekly. Optionally, the antibody is administeredat a dose of 2.5-5 mg weekly. Optionally, the antibody is administeredat a dose of 4-5 mg weekly. Optionally, the antibody is administered ata dose of 7-10 mg biweekly.

The invention provides methods of treating Alzheimer disease, comprisingadministering to a patient having the disease an antibody thatspecifically binds to an N-terminal fragment of Aβ in a regimesufficient to maintain a maximum serum concentration of the antibody inthe patient less than about 28 μg antibody/ml serum and thereby treatingthe patient. Optionally, the maximum serum concentration is within arange of about 4-28 μg antibody/ml serum. Optionally, the maximum serumconcentration is within a range of about 4-18 μg antibody/ml serum.Optionally, the average serum concentration of the antibody in thepatient is below about 7 μg antibody/ml serum. Optionally, the averageserum concentration is within a range of about 2-7 μg antibody/ml serum.Optionally, the average serum concentration is about 5 μg antibody/mlserum. Optionally, the antibody is administered intravenously.Optionally, the antibody is administered subcutaneously. Optionally, adose of 0.1-1.0 mg/kg is administered monthly. Optionally, a dose of0.5-1.0 mg/kg is administered monthly. Optionally, the antibody isadministered at a frequency between weekly and monthly. Optionally, theantibody is administered weekly or biweekly. Some methods furthercomprise measuring the concentration of antibody in the serum andadjusting the regime if the measured concentration falls outside therange. Optionally, the antibody is a humanized antibody. Optionally, thehumanized antibody is a humanized version of mouse antibody 3D6expressed by the hybridoma deposited under ATCC under No. PTA-5130.Optionally, the humanized antibody is bapineuzumab. Optionally, thehumanized antibody is a humanized version of mouse antibody 10D5expressed by the hybridoma deposited under ATCC under No. PTA-5129.Optionally, the humanized antibody is a humanized version of mouseantibody 12A11 expressed by the hybridoma deposited under ATCC under No.PTA-7271.

The invention provides methods of treating Alzheimer disease, comprisingadministering to a patient having the disease an antibody thatspecifically binds to an N-terminal fragment of Aβ in a regimesufficient to maintain an average serum concentration of the antibody inthe patient below about 7 μg antibody/ml serum and thereby treat thepatient. Optionally, the average serum concentration is within a rangeof about 2-7 μg antibody/ml serum. Optionally, the average serumconcentration is about 5 μg antibody/ml serum. Optionally, the antibodyis administered intravenously. Optionally, the antibody is administeredsubcutaneously. Optionally, a dose of 0.1-1.0 mg/kg is administeredmonthly. Optionally, a dose of 0.5-1.0 mg/kg is administered monthly.Optionally, the antibody is administered at a frequency between weeklyand monthly. Optionally, the antibody is administered weekly orbiweekly. Some methods further comprise measuring the concentration ofantibody in the serum and adjusting the regime if the measuredconcentration falls outside the range. Optionally, the antibody is ahumanized antibody. Optionally, the humanized antibody is a humanizedversion of mouse antibody 3D6 expressed by the hybridoma deposited underATCC under No. PTA-5130. Optionally, the humanized antibody isbapineuzumab. Optionally, the humanized antibody is a humanized versionof mouse antibody 10D5 expressed by the hybridoma deposited under ATCCunder No. PTA-5129. Optionally, the humanized antibody is a humanizedversion of mouse antibody 12A11 expressed by the hybridoma depositedunder ATCC under No. PTA-7271.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows light (SEQ ID NO: 30) and heavy chain (SEQ ID NO: 31) aminoacid sequence of Bapineuzumab predicted from the expression constructDNA sequences.

FIG. 2 shows the average MMSE change from baseline.

FIG. 3 shows the change from baseline MMSE by cohort at month 4.

FIG. 4 shows the mean, median and standard deviation MMSE change frombaseline at month four.

FIG. 5 shows the results of statistical testing of the MMSE change frombaseline at month four.

FIG. 6 shows simulated steady state serum concentrations of antibodyfrom various subcutaneous regimes assuming bioavailability of 70%.

FIG. 7 shows steady state concentrations of antibody followingsubcutaneous administration of AAB-001 at doses of 0.05 or 0.06 mg/kgassuming 70% or 100% bioavailability.

FIG. 8 shows plasma Aβ levels following administration of AAB-001 atdoses of 0.15, 0.5, or 1.0 mg/kg.

FIG. 9 shows pharmacokinetic parameters following intravenousadministration of AAB-001 at doses of 0.15, 0.5, 1.0, and 2.0 mg/kg.

FIG. 10 shows the mean serum AAB-001 concentration vs. time profilesfollowing intravenous administration of AAB-001 at doses of 0.15, 0.5,1.0, and 2.0 mg/kg.

FIG. 11 shows plasma Aβ levels following intravenous administration ofAAB-001 at doses of 0.15, 0.5, and 1.0 mg/kg.

DETAILED DESCRIPTION OF THE INVENTION

The application provides preferred dosages and frequencies ofadministration of antibodies to an N-terminal fragment of Aβ to maximizetherapeutic benefit relative to occurrence of side effects, particularlyvasogenic edema. A series of experiments using different regimes of themouse 3D6 antibody in transgenic PDAPP mouse have identified a steadystate average serum concentration of antibody of about 3.7 μg/ml forreducing amyloid accumulation. The present data provide evidence thatdoses of 0.5 mg/kg and 1.5 mg/kg administered intravenously every 13weeks were effective in inhibiting cognitive decline in Alzheimer'spatients. These regimes give rise to average serum concentrations ofantibody that bracket the effective dose of 3.7 μg/ml in mice. Forexample, a dose of 0.5 mg/kg administered every 13 weeks was found togive an average serum concentration of about 3 μg/ml. A dose of 1 mg/kgadministered every 13 weeks was found to give an average serumconcentration of about 5.5 μg/ml and a dose of 2 mg/kg administeredevery 13 weeks was predicted to give an average serum concentration of9.4 μg/ml. Thus, the present data indicate that the same order ofmagnitude of serum concentrations of antibody that are effective in miceare effective in humans. These data are further supported by clinicaltrials using immunotherapy with full-length Aβ1-42. In these trials,antibody responders were found to have a statistically significantinhibition of cognitive decline. The antibody responders had an ELISAtiter of antibody of at least 1 in 2200, which corresponds to a serumtiter of about 1 μg/ml.

The present data also provide evidence that higher doses of antibodyparticularly 5 mg/kg achieve no greater (and possibly less) therapeuticbenefit than lower doses in the 0.5-1.5 mg/kg range but also producesignificant side effects, particularly vasogenic edema, in somepatients. Although practice of the present invention is not dependent onan understanding of mechanism, it is believed that the side effectsresult from high maximum concentrations of antibody following itsadministration.

In the aggregate, these data indicate that therapeutic benefit can beobtained with relatively modest doses of antibody designed to givesimilar average serum concentrations to the 3.7 μg/ml found effective inmice or the values bracketing this figure which appear to be effectivein humans. The present data also indicate that for regimes deliveringequivalent areas under the curve in terms of serum concentration ofantibody as a function of time that smaller dosages administered morefrequently have a better efficacy to side effects profile than largedosages administered less frequently because the former regimes avoidthe spikes in antibody concentration attendant to administering largerdoses in the latter regimes. In the study in the present examples, doseswere administered intravenously every 13 weeks. Although the intervalfor doses can be reduced to about monthly with commensurate reductionsin individual doses, further increase in the frequency to weekly orbiweekly (biweekly) has a high risk of noncompliance due to theinconvenience of intravenous administration, which usually requires avisit to an infusion center. However, weekly or biweekly dosing ispractical by subcutaneous administration, which can easily beself-administered or administered by a caregiver without medicaltraining. Subcutaneous delivery also results in more gradual delivery tothe blood avoiding spikes in concentration. The bioavailability measuredby area under the curve of antibody in plasma of subcutaneous deliveryrelative to intravenous delivery is about 70-100%.

Thus, preferred regimes for administering antibodies specificallybinding to an N-terminal fragment of Aβ achieves an average serumconcentration of administered antibody of 1-15 μg/ml in a patient. Thisrange brackets the demonstrated effective concentrations in mice andhumans allowing some margin for error in measurement and individualpatient variation. The serum concentration can be determined by actualmeasurement or predicted from standard pharmacokinetics (e.g.,WinNonline Version 4.0.1 (Pharsight Corporation, Cary, USA)) based onthe amount of antibody administered, frequency of administration, routeof administration and antibody half-life. The average antibodyconcentration in the serum is preferably within a range of 1-10, 1-5 or2-4 μg/ml.

The present data also provide evidence that administering an antibodythat specifically binds to an N-terminal fragment of Aβ in a regimesufficient to maintain a maximum serum concentration of the antibody inthe patient less than about 28 μg antibody/ml serum maximizestherapeutic benefit relative to the occurrence of possible side effects,particularly vascular edema. A preferred maximum serum concentration iswithin a range of about 4-28 μg antibody/ml serum. The combination ofmaximum serum less than about 28 μg antibody/ml serum and an averageserum concentration of the antibody in the patient is below about 7 μgantibody/ml serum is particularly beneficial. See FIGS. 9 and 10.

The present data also provide evidence that administering an antibodythat specifically binds to an N-terminal fragment of Aβ in a regimesufficient to maintain an average serum concentration of the antibodybelow about 7 μg antibody/ml serum maximizes therapeutic benefitrelative to the occurrence of possible side effects, particularlyvascular edema. A preferred average concentration is within a range ofabout 2-7 μg antibody/ml serum.

If the antibody is administered intravenously it is as discussed aboveinconvenient to have to administer it more frequently than aboutmonthly. Preferred doses of antibody for monthly intravenousadministration occur in the range of 0.1-1.0 mg/kg antibody orpreferably 0.5-1.0 mg/kg antibody.

For more frequent dosing, e.g., from weekly to monthly dosing,subcutaneous administration is preferred. The doses used forsubcutaneous dosing are usually in the range of 0.1 to 0.6 mg/kg or0.01-0.35 mg/kg, preferably, 0.05-0.25 mg/kg. For weekly or biweeklydosing, the dose is preferably in the range of 0.015-0.2 mg/kg, or0.05-0.15 mg/kg. For weekly dosing, the dose is preferably 0.05 to 0.07mg/kg, e.g., about 0.06 mg/kg. For biweekly dosing, the dose ispreferably 0.1 to 0.15 mg/kg. For monthly dosing, the dose is preferably0.1 to 0.3 mg/kg or about 2 mg/kg. Monthly dosing includes dosing by thecalendar month or lunar month (i.e., every four weeks).

FIG. 6 shows simulated steady state serum concentrations of antibodyfrom various subcutaneous regimes assuming bioavailability of 70%. Itcan be seen that a dose of 0.1 mg/kg gives an average serumconcentration very close to the 3.7 μg/ml found effective in mice withlittle peak to trough variation. FIG. 7 shows steady stateconcentrations of antibody following subcutaneous administration atdoses of 0.05 and 0.06 mg/kg assuming 70% or 100% bioavailability. Itcan be seen that at 70% bioavailability, the 0.05 and 0.06 mg/kg doseslie just below and above the 3.7 μg/ml dose found effective in mice withlittle peak to trough variation.

The treatment regime is usually continued so that the average serumconcentrations of antibody described above are maintained for at leastsix months or a year, and sometimes for life. The serum concentrationcan be measured at any time during treatment and the dose and/orfrequency of administration increased if the average concentration fallsbeneath a target range or the dose and/or frequency decreased if theaverage concentration falls above a target range.

Although determining optimal plasma concentrations of antibody is usefulin determining a dosage regime or optimizing dosage in an individualpatient, in practice once an effective dosage regime in terms of mg/kgor mg and frequency of administration has been determined, the samedosage regime can be used on many other patients without the need fordetailed calculation or measurement of patient titers. Thus, any of theabove mentioned dosages and treatment regimes can be used irrespectivewhether a titer is measured or predicted in a particular patient. Forexample, one suitable regime is intravenous administration at monthlyintervals with a dose in range of 0.1-1.0 mg/kg antibody or preferably0.5-1.0 mg/kg antibody. For subcutaneous dosing the dose used is usuallyin the range of 0.01-0.6 mg/kg or 0.01-0.35 mg/kg, preferably, 0.05-0.25mg/kg. For weekly or biweekly dosing, the dose is preferably in therange of 0.015-0.2 mg/kg, or 0.05-0.15 mg/kg. For weekly dosing, thedose is preferably 0.05 to 0.07 mg/kg, e.g., 0.06 mg/kg. For biweeklydosing, the dose is preferably 0.1 to 0.15 mg/kg. For monthly dosing,the dose is preferably 0.1 to 0.3 mg/kg or 2 mg/kg.

Here as elsewhere in the application, dosages expressed in mg/kg can beconverted to absolute mass dosages by multiplying by the mass of atypical patient (e.g., 70 or 75 kg) typically rounding to a wholenumber. Expressed in terms of absolute mass, antibodies are usuallyadministered at a dose of 1-40 mg at a frequency of between weekly andmonthly. Preferred ranges are 5-25 mg or 2.5-15 mg at a frequency ofweekly to monthly. For weekly to biweekly administration, the dose isoften 1-12 mg or 2.5 to 10 mg. For weekly administration, the dose isoften 2.5 to 5 mg or 4-5 mg. For biweekly administration, the dose canbe 7-10 mg. The mass of antibody packaged for administration in unitdoses is usually round to whole number, such as 1, 5, 10, 20, 30, 40,50, 75 or 100 mg.

The invention provides preferred dosage ranges and monitoring regimesfor use in treatment of Alzheimer's disease using antibodies to Aβ. Themethods are premised in part on results of a clinical trial described inthe Examples. A preferred dosage range for antibodies that bind to anN-terminal fragment of Aβ is from about 0.5 to 5 mg antibody per kgpatient body weight. Preferred dosages are less than 5 mg/kg. Dosagesfrom 0.5 to 3 mg/kg, 0.5 to 1.5 mg/kg and 1.5 mg/kg are particularlypreferred.

The invention also provides monitoring regimes that can assess changesin symptoms or signs of the patient following treatment. The symptoms orsigns can relate to Alzheimer's disease itself and/or side effects ofthe treatment. The dosage of drug or its frequency of administration canbe adjusted based on the outcome of the monitoring. Alternatively oradditionally, additional drugs can be administered to treat any sideeffects. For example, monitoring by MRI and/or FLAIR sequence imagingcan be used to detect PRES or vascular edema or signs or symptomsthereof. Presence of PRES or vascular edema is an indication that thedosage should be reduced or suspended, or the interval betweenadministration of dosages increased. Alternatively, or additionally, thepatient can be administered a steroid to treat the PRES or vascularedema. After reducing or suspending dosage or increasing the intervalbetween dosages, and/or administering the steroid, continued monitoringcan indicate disappearance of PRES or vascular edema, in which case theoriginal amount and/or interval of dosing can be resumed. Administrationof the steroid may or may not be continued as a prophylactic measure atthis point. As another example, monitoring of blood pressure canindicate development of hypertension. In analogous fashion, the dosagecan be reduced in amount or suspended, and/or intervals between dosageincreased and/or an antihypertensive administered. If and when furthermonitoring indicates the hypertension has disappeared, the originalamount and/or interval of dosing can be resumed. Administration ofantihypertensive may or may not be continued as a prophylactic measureat this point.

Prior to describing the invention, it may be helpful to an understandingthereof to set forth definitions of certain terms to be usedhereinafter.

The term “immunoglobulin” or “antibody” (used interchangeably herein)refers to an antigen-binding protein having a basic four-polypeptidechain structure consisting of two heavy and two light chains, saidchains being stabilized, for example, by interchain disulfide bonds,which has the ability to specifically bind antigen. Both heavy and lightchains are folded into domains. The term “domain” refers to a globularregion of a heavy or light chain polypeptide comprising peptide loops(e.g., comprising 3 to 4 peptide loops) stabilized, for example, byβ-pleated sheet and/or intrachain disulfide bond. Domains are furtherreferred to herein as “constant” or “variable”, based on the relativelack of sequence variation within the domains of various class membersin the case of a “constant” domain, or the significant variation withinthe domains of various class members in the case of a “variable” domain.“Constant” domains on the light chain are referred to interchangeably as“light chain constant regions”, “light chain constant domains”, “CL”regions or “CL” domains). “Constant” domains on the heavy chain arereferred to interchangeably as “heavy chain constant regions”, “heavychain constant domains”, “CH” regions or “CH” domains). “Variable”domains on the light chain are referred to interchangeably as “lightchain variable regions”, “light chain variable domains”, “VL” regions or“VL” domains). “Variable” domains on the heavy chain are referred tointerchangeably as “heavy chain constant regions”, “heavy chain constantdomains”, “CH” regions or “CH” domains).

The term “region” refers to a part or portion of an antibody chain andincludes constant or variable domains as defined herein, as well as morediscrete parts or portions of said domains. For example, light chainvariable domains or regions include “complementarity determiningregions” or “CDRs” interspersed among “framework regions” or “FRs”, asdefined herein.

Immunoglobulins or antibodies can exist in monomeric or polymeric form.The term “antigen-binding fragment” refers to a polypeptide fragment ofan immunoglobulin or antibody binds antigen or competes with intactantibody (i.e., with the intact antibody from which they were derived)for antigen binding (i.e., specific binding). The term “conformation”refers to the tertiary structure of a protein or polypeptide (e.g., anantibody, antibody chain, domain or region thereof). For example, thephrase “light (or heavy) chain conformation” refers to the tertiarystructure of a light (or heavy) chain variable region, and the phrase“antibody conformation” or “antibody fragment conformation” refers tothe tertiary structure of an antibody or fragment thereof.

“Specific binding” of an antibody mean that the antibody exhibitsappreciable affinity for antigen or a preferred epitope and, preferably,does not exhibit significant cross reactivity. “Appreciable” orpreferred binding include binding with an affinity of at least 10⁶, 10⁷,10⁸, 10⁹ M⁻¹, or 10¹⁰ M⁻¹. Affinities greater than 10⁷ M⁻¹, preferablygreater than 10⁸ M⁻¹ are more preferred. Values intermediate of thoseset forth herein are also intended to be within the scope of the presentinvention and a preferred binding affinity can be indicated as a rangeof affinities, for example, 10⁶ to 10¹⁰ M⁻¹, preferably 10⁷ to 10¹⁰ M⁻¹,more preferably 10⁸ to 10¹⁰ M⁻¹. An antibody that “does not exhibitsignificant cross reactivity” is one that will not appreciably bind toan undesirable entity (e.g., an undesirable proteinaceous entity). Forexample, an antibody that specifically binds to Aβ will appreciably bindAβ but will not significantly react with non-Aβ proteins or peptides(e.g., non-Aβ proteins or peptides included in plaques). An antibodyspecific for a preferred epitope will, for example, not significantlycross react with remote epitopes on the same protein or peptide.Specific binding can be determined according to any art-recognized meansfor determining such binding. Preferably, specific binding is determinedaccording to Scatchard analysis and/or competitive binding assays.

Binding fragments are produced by recombinant DNA techniques, or byenzymatic or chemical cleavage of intact immunoglobulins. Bindingfragments include Fab, Fab′, F(ab′)₂, Fabc, Fv, single chains, andsingle-chain antibodies. Other than “bispecific” or “bifunctional”immunoglobulins or antibodies, an immunoglobulin or antibody isunderstood to have each of its binding sites identical. A “bispecific”or “bifunctional antibody” is an artificial hybrid antibody having twodifferent heavy/light chain pairs and two different binding sites.Bispecific antibodies can be produced by a variety of methods includingfusion of hybridomas or linking of Fab′ fragments. See, e.g.,Songsivilai & Lachmann, Clin. Exp. Immunol. 79:315-321 (1990); Kostelnyet al., J. Immunol. 148, 1547-1553 (1992).

The term “humanized immunoglobulin” or “humanized antibody” refers to animmunoglobulin or antibody that includes at least one humanizedimmunoglobulin or antibody chain (i.e., at least one humanized light orheavy chain). The term “humanized immunoglobulin chain” or “humanizedantibody chain” (i.e., a “humanized immunoglobulin light chain” or“humanized immunoglobulin heavy chain”) refers to an immunoglobulin orantibody chain (i.e., a light or heavy chain, respectively) having avariable region that includes a variable framework region substantiallyfrom a human immunoglobulin or antibody and complementarity determiningregions (CDRs) (e.g., at least one CDR, preferably two CDRs, morepreferably three CDRs) substantially from a non-human immunoglobulin orantibody, and further includes constant regions (e.g., at least oneconstant region or portion thereof, in the case of a light chain, andpreferably three constant regions in the case of a heavy chain). Theterm “humanized variable region” (e.g., “humanized light chain variableregion” or “humanized heavy chain variable region”) refers to a variableregion that includes a variable framework region substantially from ahuman immunoglobulin or antibody and complementarity determining regions(CDRs) substantially from a non-human immunoglobulin or antibody.

The phrase “substantially from a human immunoglobulin or antibody” or“substantially human” means that, when aligned to a human immunoglobulinor antibody amino sequence for comparison purposes, the region shares atleast 80-90%, preferably 90-95%, more preferably 95-99% identity (i.e.,local sequence identity) with the human framework or constant regionsequence, allowing, for example, for conservative substitutions,consensus sequence substitutions, germline substitutions, backmutations,and the like. The introduction of conservative substitutions, consensussequence substitutions, germline substitutions, backmutations, and thelike, is often referred to as “optimization” of a humanized antibody orchain. The phrase “substantially from a non-human immunoglobulin orantibody” or “substantially non-human” means having an immunoglobulin orantibody sequence at least 80-95%, preferably 90-95%, more preferably,96%, 97%, 98%, or 99% identical to that of a non-human organism, e.g., anon-human mammal.

Accordingly, all regions or residues of a humanized immunoglobulin orantibody, or of a humanized immunoglobulin or antibody chain, exceptpossibly the CDRs, are substantially identical to the correspondingregions or residues of one or more native human immunoglobulinsequences. The term “corresponding region” or “corresponding residue”refers to a region or residue on a second amino acid or nucleotidesequence which occupies the same (i.e., equivalent) position as a regionor residue on a first amino acid or nucleotide sequence, when the firstand second sequences are optimally aligned for comparison purposes.

The terms “humanized immunoglobulin” or “humanized antibody” are notintended to encompass chimeric immunoglobulins or antibodies, as definedinfra. Although humanized immunoglobulins or antibodies are chimeric intheir construction (i.e., comprise regions from more than one species ofprotein), they include additional features (i.e., variable regionscomprising donor CDR residues and acceptor framework residues) not foundin chimeric immunoglobulins or antibodies, as defined herein.

The term “chimeric immunoglobulin” or antibody refers to animmunoglobulin or antibody whose variable regions derive from a firstspecies and whose constant regions derive from a second species.Chimeric immunoglobulins or antibodies can be constructed, for exampleby genetic engineering, from immunoglobulin gene segments belonging todifferent species.

An “antigen” is an entity (e.g., a protenaceous entity or peptide) towhich an antibody specifically binds.

The term “epitope” or “antigenic determinant” refers to a site on anantigen to which an immunoglobulin or antibody (or antigen bindingfragment thereof) specifically binds. Epitopes can be formed both fromcontiguous amino acids or noncontiguous amino acids juxtaposed bytertiary folding of a protein. Epitopes formed from contiguous aminoacids are typically retained on exposure to denaturing solvents whereasepitopes formed by tertiary folding are typically lost on treatment withdenaturing solvents. An epitope typically includes at least 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14 or 15 amino acids in a unique spatialconformation. Methods of determining spatial conformation of epitopesinclude, for example, x-ray crystallography and 2-dimensional nuclearmagnetic resonance. See, e.g., Epitope Mapping Protocols in Methods inMolecular Biology, Vol. 66, G. E. Morris, Ed. (1996).

Antibodies that recognize the same epitope can be identified in a simpleimmunoassay showing the ability of one antibody to block the binding ofanother antibody to a target antigen, i.e., a competitive binding assay.Competitive binding is determined in an assay in which theimmunoglobulin under test inhibits specific binding of a referenceantibody to a common antigen, such as Aβ. Numerous types of competitivebinding assays are known, for example: solid phase direct or indirectradioimmunoassay (RIA), solid phase direct or indirect enzymeimmunoassay (EIA), sandwich competition assay (see Stahli et al.,Methods in Enzymology 9:242 (1983)); solid phase direct biotin-avidinEIA (see Kirkland et al., J. Immunol. 137:3614 (1986)); solid phasedirect labeled assay, solid phase direct labeled sandwich assay (seeHarlow and Lane, Antibodies: A Laboratory Manual, Cold Spring HarborPress (1988)); solid phase direct label RIA using 1-125 label (see Morelet al., Mol. Immunol. 25(1):7 (1988)); solid phase direct biotin-avidinEIA (Cheung et al., Virology 176:546 (1990)); and direct labeled RIA.(Moldenhauer et al., Scand. J. Immunol. 32:77 (1990)). Typically, suchan assay involves the use of purified antigen bound to a solid surfaceor cells bearing either of these, an unlabeled test immunoglobulin and alabeled reference immunoglobulin. Competitive inhibition is measured bydetermining the amount of label bound to the solid surface or cells inthe presence of the test immunoglobulin. Usually the test immunoglobulinis present in excess. Usually, when a competing antibody is present inexcess, it will inhibit specific binding of a reference antibody to acommon antigen by at least 50-55%, 55-60%, 60-65%, 65-70% 70-75% ormore.

An epitope is also recognized by immunologic cells, for example, B cellsand/or T cells. Cellular recognition of an epitope can be determined byin vitro assays that measure antigen-dependent proliferation, asdetermined by ³H-thymidine incorporation, by cytokine secretion, byantibody secretion, or by antigen-dependent killing (cytotoxic Tlymphocyte assay).

Exemplary epitopes or antigenic determinants can be found within thehuman amyloid precursor protein (APP), but are preferably found withinthe Aβ peptide of APP. Multiple isoforms of APP exist, for exampleAPP⁶⁹⁵, APP⁷⁵¹ and APP⁷⁷⁰. Amino acids within APP are assigned numbersaccording to the sequence of the APP⁷⁷⁰ isoform (see e.g., GenBankAccession No. P05067, also set forth as SEQ ID NO:38). Aβ (also referredto herein as beta amyloid peptide and A-beta) peptide is a ˜4-kDainternal fragment of 39-43 amino acids of APP (Aβ39, Aβ40, Aβ41, Aβ42and Aβ43). Aβ40, for example, consists of residues 672-711 of APP andAβ42 consists of residues 673-713 of APP. As a result of proteolyticprocessing of APP by different secretase enzymes iv vivo or in situ, Aβis found in both a “short form”, 40 amino acids in length, and a “longform”, ranging from 42-43 amino acids in length. Preferred epitopes orantigenic determinants, as described herein, are located within theN-terminus of the Aβ peptide and include residues within amino acids1-10 of Aβ, preferably from residues 1-3, 1-4, 1-5, 1-6, 1-7 or 3-7 ofAβ42. Additional referred epitopes or antigenic determinants includeresidues 2-4, 5, 6, 7 or 8 of Aβ, residues 3-5, 6, 7, 8 or 9 of Aβ, orresidues 4-7, 8, 9 or 10 of Aβ42.

The term “amyloidogenic disease” includes any disease associated with(or caused by) the formation or deposition of insoluble amyloid fibrils.Exemplary amyloidogenic diseases include, but are not limited tosystemic amyloidosis, Alzheimer's disease, mature onset diabetes,Parkinson's disease, Huntington's disease, fronto-temporal dementia, andthe prion-related transmissible spongiform encephalopathies (kuru andCreutzfeldt-Jacob disease in humans and scrapie and BSE in sheep andcattle, respectively). Different amyloidogenic diseases are defined orcharacterized by the nature of the polypeptide component of the fibrilsdeposited. For example, in subjects or patients having Alzheimer'sdisease, β-amyloid protein (e.g., wild-type, variant, or truncatedβ-amyloid protein) is the characterizing polypeptide component of theamyloid deposit. Accordingly, Alzheimer's disease is an example of a“disease characterized by deposits of Aβ” or a “disease associated withdeposits of Aβ”, e.g., in the brain of a subject or patient. The terms“β-amyloid protein”, “β-amyloid peptide”, “β-amyloid”, “Aβ” and “Aβpeptide” are used interchangeably herein.

The term “effective dose” or “effective dosage” is defined as an amountsufficient to achieve or at least partially achieve the desired effect.The term “therapeutically effective dose” is defined as an amountsufficient to cure or at least partially arrest the disease and itscomplications in a patient already suffering from the disease. Amountseffective for this use will depend upon the severity of the infectionand the general state of the patient's own immune system.

The term “patient” includes human and other mammalian subjects thatreceive either prophylactic or therapeutic treatment.

“Soluble” or “dissociated” Aβ refers to non-aggregating or disaggregatedAβ polypeptide. “Insoluble” Aβ refers to aggregating Aβ polypeptide, forexample, Aβ held together by noncovalent bonds. Aβ (e.g., Aβ42) isbelieved to aggregate, at least in part, due to the presence ofhydrophobic residues at the C-terminus of the peptide (part of thetransmembrane domain of APP). One method to prepare soluble Aβ is todissolve lyophilized peptide in neat DMSO with sonication. The resultingsolution is centrifuged to remove any insoluble particulates.

The term “effector function” refers to an activity that resides in theFc region of an antibody (e.g., an IgG antibody) and includes, forexample, the ability of the antibody to bind effector molecules such ascomplement and/or Fc receptors, which can control several immunefunctions of the antibody such as effector cell activity, lysis,complement-mediated activity, antibody clearance, and antibodyhalf-life.

The term “effector molecule” refers to a molecule that is capable ofbinding to the Fc region of an antibody (e.g., an IgG antibody)including, but not limited to, a complement protein or a Fc receptor.

The term “effector cell” refers to a cell capable of binding to the Fcportion of an antibody (e.g., an IgG antibody) typically via an Fcreceptor expressed on the surface of the effector cell including, butnot limited to, lymphocytes, e.g., antigen presenting cells and T cells.

The term “Fc region” refers to a C-terminal region of an IgG antibody,in particular, the C-terminal region of the heavy chain(s) of said IgGantibody. Although the boundaries of the Fc region of an IgG heavy chaincan vary slightly, a Fc region is typically defined as spanning fromabout amino acid residue Cys226 to the carboxyl-terminus of an IgG heavychain(s).

The term “Kabat numbering” unless otherwise stated, is defined as thenumbering of the residues in, e.g., an IgG heavy chain antibody usingthe EU index as in Kabat et al. (Sequences of Proteins of ImmunologicalInterest, 5th Ed. Public Health Service, National Institutes of Health,Bethesda, Md. (1991)), expressly incorporated herein by reference.

The term “Fc receptor” or “FcR” refers to a receptor that binds to theFc region of an antibody. Typical Fc receptors which bind to an Fcregion of an antibody (e.g., an IgG antibody) include, but are notlimited to, receptors of the FcγRI, FcγRII, and FcγRIII subclasses,including allelic variants and alternatively spliced forms of thesereceptors. Fc receptors are reviewed in Ravetch and Kinet, Annu. Rev.Immunol 9:457-92 (1991); Capel et al., Immunomethods 4:25-34 (1994); andde Haas et al., J. Lab. Clin. Med. 126:330-41 (1995).

Immunological and Therapeutic Reagents

Immunological and therapeutic reagents of the invention comprise orconsist of immunogens or antibodies, or functional or antigen bindingfragments thereof, as defined herein. The basic antibody structural unitis known to comprise a tetramer of subunits. Each tetramer is composedof two identical pairs of polypeptide chains, each pair having one“light” (about 25 kDa) and one “heavy” chain (about 50-70 kDa). Theamino-terminal portion of each chain includes a variable region of about100 to 110 or more amino acids primarily responsible for antigenrecognition. The carboxy-terminal portion of each chain defines aconstant region primarily responsible for effector function.

Antibodies

The term “antibody” as used herein refers to immunoglobulin moleculesand immunologically active portions of immunoglobulin molecules, i.e.,molecules that contain an antigen binding site which specifically binds(recognizes) an antigen. Examples of immunologically active portions ofimmunoglobulin molecules include F(ab) and F(ab′)2 fragments which canbe generated by treating the antibody with an enzyme such as pepsin orproduced by art-recognized recombinant engineering techniques. Aspectsof the invention also relevant for the stabilization of antibodiesinclude, for example, polyclonal and monoclonal antibodies that bind anantigen, for example a therapeutic target antigen, such as, Aβ. The term“monoclonal antibody” or “monoclonal antibody composition”, as usedherein, refers to a population of antibody molecules that contain onlyone species of an antigen binding site capable of recognizing andbinding to a particular epitope of a target antigen, for example, anepitope(s) of Aβ. A monoclonal antibody composition thus typicallydisplays a single binding specificity and affinity for a particulartarget antigen with which it immunoreacts.

Polyclonal Antibodies

Polyclonal antibodies can be prepared as described above by immunizing asuitable subject with an immunogen. The antibody titer in the immunizedsubject can be monitored over time by standard techniques, such as withan enzyme linked immunosorbent assay (ELISA) using immobilized targetantigen. If desired, the antibody molecules directed against the targetantigen can be isolated from the mammal (e.g., from the blood) andfurther purified by well known techniques, such as protein A Sepharosechromatography to obtain the antibody, e.g., IgG, fraction. At anappropriate time after immunization, e.g., when the anti-antigenantibody titers are highest, antibody-producing cells can be obtainedfrom the subject and used to prepare monoclonal antibodies by standardtechniques, such as the hybridoma technique originally described byKohler and Milstein (1975) Nature 256:495-497) (see also, Brown et al.(1981) J. Immunol. 127:539-46; Brown et al. (1980) J. Biol. Chem.255:4980-83; Yeh et al. (1976) Proc. Natl. Acad. Sci. USA 76:2927-31;and Yeh et al. (1982) Int. J. Cancer 29:269-75). For the preparation ofchimeric polyclonal antibodies, see Buechler et al. U.S. Pat. No.6,420,113.

Monoclonal Antibodies

Any of the many well known protocols used for fusing lymphocytes andimmortalized cell lines can be applied for the purpose of generating amonoclonal antibody (see, e.g., G. Galfre et al. (1977) Nature266:55052; Gefter et al. Somatic Cell Genet., cited supra; Lerner, YaleJ. Biol. Med., cited supra; Kenneth, Monoclonal Antibodies, citedsupra). Moreover, the ordinarily skilled worker will appreciate thatthere are many variations of such methods which also would be useful.Typically, the immortal cell line (e.g., a myeloma cell line) is derivedfrom the same mammalian species as the lymphocytes. For example, murinehybridomas can be made by fusing lymphocytes from a mouse immunized withan immunogenic preparation of the present invention with an immortalizedmouse cell line. Preferred immortal cell lines are mouse myeloma celllines that are sensitive to culture medium containing hypoxanthine,aminopterin and thymidine (“HAT medium”). Any of a number of myelomacell lines can be used as a fusion partner according to standardtechniques, e.g., the P3-NS1/1-Ag4-1, P3-x63-Ag8.653 or Sp2/O—Ag14myeloma lines. These myeloma lines are available from ATCC. Typically,HAT-sensitive mouse myeloma cells are fused to mouse splenocytes usingpolyethylene glycol (“PEG”). Hybridoma cells resulting from the fusionare then selected using HAT medium, which kills unfused andunproductively fused myeloma cells (unfused splenocytes die afterseveral days because they are not transformed). Hybridoma cellsproducing a monoclonal antibody of the invention are detected byscreening the hybridoma culture supernatants for antibodies that bind atarget antigen, e.g., Aβ, using a standard ELISA assay.

Recombinant Antibodies

Alternative to preparing monoclonal antibody-secreting hybridomas, amonoclonal antibody can be identified and isolated by screening arecombinant combinatorial immunoglobulin library (e.g., an antibodyphage display library) with a target antigen to thereby isolateimmunoglobulin library members that bind the target antigen. Kits forgenerating and screening phage display libraries are commerciallyavailable (e.g., the Pharmacia Recombinant Phage Antibody System,Catalog No. 27-9400-01; and the Stratagene SurfZAP™ Phage Display Kit,Catalog No. 240612). Additionally, examples of methods and reagentsparticularly amenable for use in generating and screening antibodydisplay library can be found in, for example, Ladner et al. U.S. Pat.No. 5,223,409; Kang et al. PCT International Publication No. WO92/18619; Dower et al. PCT International Publication No. WO 91/17271;Winter et al. PCT International Publication WO 92/20791; Markland et al.PCT International Publication No. WO 92/15679; Breitling et al. PCTInternational Publication WO 93/01288; McCafferty et al. PCTInternational Publication No. WO 92/01047; Garrard et al. PCTInternational Publication No. WO 92/09690; Ladner et al. PCTInternational Publication No. WO 90/02809; Fuchs et al. (1991)Bio/Technology 9:1370-1372; Hay et al. (1992) Hum. Antibod. Hybridomas3:81-85; Huse et al. (1989) Science 246:1275-1281; Griffiths et al.(1993) EMBO J12:725-734; Hawkins et al. (1992) J. Mol. Biol.226:889-896; Clarkson et al. (1991) Nature 352:624-628; Gram et al.(1992) Proc. Natl. Acad. Sci. USA 89:3576-3580; Garrad et al. (1991)Bio/Technology 9:1373-1377; Hoogenboom et al. (1991) Nuc. Acid Res.19:4133-4137; Barbas et al. (1991) Proc. Natl. Acad. Sci. USA88:7978-7982; and McCafferty et al. Nature (1990) 348:552-554.

Chimeric and Humanized Antibodies

Additionally, recombinant antibodies, such as chimeric and humanizedmonoclonal antibodies, comprising both human and non-human portions,which can be made using standard recombinant DNA techniques, are withinthe scope of the invention.

The term “humanized immunoglobulin” or “humanized antibody” refers to animmunoglobulin or antibody that includes at least one humanizedimmunoglobulin or antibody chain (i.e., at least one humanized light orheavy chain). The term “humanized immunoglobulin chain” or “humanizedantibody chain” (i.e., a “humanized immunoglobulin light chain” or“humanized immunoglobulin heavy chain”) refers to an immunoglobulin orantibody chain (i.e., a light or heavy chain, respectively) having avariable region that includes a variable framework region substantiallyfrom a human immunoglobulin or antibody and complementarity determiningregions (CDRs) (e.g., at least one CDR, preferably two CDRs, morepreferably three CDRs) substantially from a non-human immunoglobulin orantibody, and further includes constant regions (e.g., at least oneconstant region or portion thereof, in the case of a light chain, andthree constant regions in the case of a heavy chain). The term“humanized variable region” (e.g., “humanized light chain variableregion” or “humanized heavy chain variable region”) refers to a variableregion that includes a variable framework region substantially from ahuman immunoglobulin or antibody and complementarity determining regions(CDRs) substantially from a non-human immunoglobulin or antibody.

The phrase “substantially from a human immunoglobulin or antibody” or“substantially human” means that, when aligned to a human immunoglobulinor antibody amino sequence for comparison purposes, the region shares atleast 80-90%, 90-95%, or 95-99% identity (i.e., local sequence identity)with the human framework or constant region sequence, allowing, forexample, for conservative substitutions, consensus sequencesubstitutions, germline substitutions, backmutations, and the like. Theintroduction of conservative substitutions, consensus sequencesubstitutions, germline substitutions, backmutations, and the like, isoften referred to as “optimization” of a humanized antibody or chain.The phrase “substantially from a non-human immunoglobulin or antibody”or “substantially non-human” means having an immunoglobulin or antibodysequence at least 80-95%, preferably at least 90-95%, more preferably,96%, 97%, 98%, or 99% identical to that of a non-human organism, e.g., anon-human mammal.

Accordingly, all regions or residues of a humanized immunoglobulin orantibody, or of a humanized immunoglobulin or antibody chain, except theCDRs, are substantially identical to the corresponding regions orresidues of one or more native human immunoglobulin sequences. The term“corresponding region” or “corresponding residue” refers to a region orresidue on a second amino acid or nucleotide sequence which occupies thesame (i.e., equivalent) position as a region or residue on a first aminoacid or nucleotide sequence, when the first and second sequences areoptimally aligned for comparison purposes.

The term “significant identity” means that two polypeptide sequences,when optimally aligned, such as by the programs GAP or BESTFIT usingdefault gap weights, share at least 50-60% sequence identity, preferablyat least 60-70% sequence identity, more preferably at least 70-80%sequence identity, more preferably at least 80-90% sequence identity,even more preferably at least 90-95% sequence identity, and even morepreferably at least 95% sequence identity or more (e.g., 99% sequenceidentity or more). The term “substantial identity” means that twopolypeptide sequences, when optimally aligned, such as by the programsGAP or BESTFIT using default gap weights, share at least 80-90% sequenceidentity, preferably at least 90-95% sequence identity, and morepreferably at least 95% sequence identity or more (e.g., 99% sequenceidentity or more). For sequence comparison, typically one sequence actsas a reference sequence, to which test sequences are compared. Whenusing a sequence comparison algorithm, test and reference sequences areinput into a computer, subsequence coordinates are designated, ifnecessary, and sequence algorithm program parameters are designated. Thesequence comparison algorithm then calculates the percent sequenceidentity for the test sequence(s) relative to the reference sequence,based on the designated program parameters.

Optimal alignment of sequences for comparison can be conducted, e.g., bythe local homology algorithm of Smith & Waterman, Adv. Appl. Math. 2:482(1981), by the homology alignment algorithm of Needleman & Wunsch, J.Mol. Biol. 48:443 (1970), by the search for similarity method of Pearson& Lipman, Proc. Nat'l. Acad. Sci. USA 85:2444 (1988), by computerizedimplementations of these algorithms (GAP, BESTFIT, FASTA, and TFASTA inthe Wisconsin Genetics Software Package, Genetics Computer Group, 575Science Dr., Madison, Wis.), or by visual inspection (see generallyAusubel et al., Current Protocols in Molecular Biology). One example ofalgorithm that is suitable for determining percent sequence identity andsequence similarity is the BLAST algorithm, which is described inAltschul et al., J. Mol. Biol. 215:403 (1990). Software for performingBLAST analyses is publicly available through the National Center forBiotechnology Information (publicly accessible through the NationalInstitutes of Health NCBI internet server). Typically, default programparameters can be used to perform the sequence comparison, althoughcustomized parameters can also be used. For amino acid sequences, theBLASTP program uses as defaults a word length (W) of 3, an expectation(E) of 10, and the BLOSUM62 scoring matrix (see Henikoff & Henikoff,Proc. Natl. Acad. Sci. USA 89:10915 (1989)).

Preferably, residue positions which are not identical differ byconservative amino acid substitutions. For purposes of classifying aminoacids substitutions as conservative or nonconservative, amino acids aregrouped as follows: Group I (hydrophobic sidechains): leu, met, ala,val, leu, ile; Group II (neutral hydrophilic side chains): cys, ser,thr; Group III (acidic side chains): asp, glu; Group IV (basic sidechains): asn, gln, his, lys, arg; Group V (residues influencing chainorientation): gly, pro; and Group VI (aromatic side chains): trp, tyr,phe. Conservative substitutions involve substitutions between aminoacids in the same class. Non-conservative substitutions constituteexchanging a member of one of these classes for a member of another.

Preferably, humanized immunoglobulins or antibodies bind antigen with anaffinity that is within a factor of three, four, or five of that of thecorresponding non-humanized antibody. For example, if the nonhumanizedantibody has a binding affinity of 10⁻⁹ M, humanized antibodies willhave a binding affinity of at least 3×10⁻⁸M, 4×10⁻⁸ M, 5×10⁻⁸ M, or 10⁻⁹M. When describing the binding properties of an immunoglobulin orantibody chain, the chain can be described based on its ability to“direct antigen (e.g., Aβ) binding”. A chain is said to “direct antigenbinding” when it confers upon an intact immunoglobulin or antibody (orantigen binding fragment thereof) a specific binding property or bindingaffinity. A mutation (e.g., a backmutation) is said to substantiallyaffect the ability of a heavy or light chain to direct antigen bindingif it affects (e.g., decreases) the binding affinity of an intactimmunoglobulin or antibody (or antigen binding fragment thereof)comprising said chain by at least an order of magnitude compared to thatof the antibody (or antigen binding fragment thereof) comprising anequivalent chain lacking said mutation. A mutation “does notsubstantially affect (e.g., decrease) the ability of a chain to directantigen binding” if it affects (e.g., decreases) the binding affinity ofan intact immunoglobulin or antibody (or antigen binding fragmentthereof) comprising said chain by only a factor of two, three, or fourof that of the antibody (or antigen binding fragment thereof) comprisingan equivalent chain lacking said mutation.

The term “chimeric immunoglobulin” or antibody refers to animmunoglobulin or antibody whose variable regions derive from a firstspecies and whose constant regions derive from a second species.Chimeric immunoglobulins or antibodies can be constructed, for exampleby genetic engineering, from immunoglobulin gene segments belonging todifferent species. The terms “humanized immunoglobulin” or “humanizedantibody” are not intended to encompass chimeric immunoglobulins orantibodies, as defined infra. Although humanized immunoglobulins orantibodies are chimeric in their construction (i.e., comprise regionsfrom more than one species of protein), they include additional features(i.e., variable regions comprising donor CDR residues and acceptorframework residues) not found in chimeric immunoglobulins or antibodies,as defined herein.

Such chimeric and humanized monoclonal antibodies can be produced byrecombinant DNA techniques known in the art, for example using methodsdescribed in Robinson et al. International Application No.PCT/US86/02269; Akira, et al. European Patent Application 184,187;Taniguchi, M., European Patent Application 171,496; Morrison et al.European Patent Application 173,494; Neuberger et al. PCT InternationalPublication No. WO 86/01533; Cabilly et al. U.S. Pat. No. 4,816,567;Cabilly et al. European Patent Application 125,023; Better et al. (1988)Science 240:1041-1043; Liu et al. (1987) Proc. Natl. Acad. Sci. USA84:3439-3443; Liu et al. (1987) J. Immunol. 139:3521-3526; Sun et al.(1987) Proc. Natl. Acad. Sci. USA 84:214-218; Nishimura et al. (1987)Canc. Res. 47:999-1005; Wood et al. (1985) Nature 314:446-449; and Shawet al. (1988) J. Natl. Cancer Inst. 80:1553-1559); Morrison, S. L.(1985) Science 229:1202-1207; Oi et al. (1986) BioTechniques 4:214;Winter U.S. Pat. No. 5,225,539; Jones et al. (1986) Nature 321:552-525;Verhoeyan et al. (1988) Science 239:1534; and Beidler et al. (1988) J.Immunol. 141:4053-4060.

Human Antibodies from Transgenic Animals and Phage Display

Alternatively, it is now possible to produce transgenic animals (e.g.,mice) that are capable, upon immunization, of producing a fullrepertoire of human antibodies in the absence of endogenousimmunoglobulin production. For example, it has been described that thehomozygous deletion of the antibody heavy-chain joining region (JH) genein chimeric and germ-line mutant mice results in complete inhibition ofendogenous antibody production. Transfer of the human germ-lineimmunoglobulin gene array in such germ-line mutant mice results in theproduction of human antibodies upon antigen challenge. See, e.g., U.S.Pat. Nos. 6,150,584; 6,114,598; and 5,770,429.

Fully human antibodies can also be derived from phage-display libraries(Hoogenboom et al., J. Mol. Biol., 227:381 (1991); Marks et al., J. Mol.Biol., 222:581-597 (1991)). Chimeric polyclonal antibodies can also beobtained from phage display libraries (Buechler et al. U.S. Pat. No.6,420,113).

Bispecific Antibodies, Antibody Fusion Polypeptides, and Single-ChainAntibodies

Bispecific antibodies (BsAbs) are antibodies that have bindingspecificities for at least two different epitopes. Such antibodies canbe derived from full length antibodies or antibody fragments (e.g.F(ab)'2 bispecific antibodies). Methods for making bispecific antibodiesare known in the art. Traditional production of full length bispecificantibodies is based on the coexpression of two immunoglobulin heavychain-light chain pairs, where the two chains have differentspecificities (Millstein et al., Nature, 305:537-539 (1983)). Because ofthe random assortment of immunoglobulin heavy and light chains, thesehybridomas (quadromas) produce a potential mixture of different antibodymolecules (see, WO 93/08829 and in Traunecker et al., EMBO J.,10:3655-3659 (1991)).

Bispecific antibodies also include cross-linked or “heteroconjugate”antibodies. For example, one of the antibodies in the heteroconjugatecan be coupled to avidin, the other to biotin or other payload.Heteroconjugate antibodies may be made using any convenientcross-linking methods. Suitable cross-linking agents are well known inthe art, and are disclosed in U.S. Pat. No. 4,676,980, along with anumber of cross-linking techniques.

In yet another aspect, the antibody can be fused, chemically orgenetically, to a payload such as a reactive, detectable, or functionalmoiety, for example, an immunotoxin to produce an antibody fusionpolypeptide. Such payloads include, for example, immunotoxins,chemotherapeutics, and radioisotopes, all of which are well-known in theart.

Single chain antibodies are also suitable for stabilization according tothe invention. The fragments comprise a heavy-chain variable domain (VH)connected to a light-chain variable domain (VL) with a linker, whichallows each variable region to interface with each other and recreatethe antigen binding pocket of the parent antibody from which the VL andVH regions are derived. See Gruber et al., J. Immunol., 152:5368 (1994).

Nanobodies

Nanobodies are antibody-derived therapeutic proteins that contain theproperties of naturally-occurring heavy chain antibodies. Nanobodies canfunction as a single, relatively small, functional antigen-bindingstructural unit, domain or protein. The Nanobody™ technology (AblynxNev.) was originally developed following the discovery that camelidae(camels and llamas) possess fully functional antibodies that lack lightchains. These heavy-chain antibodies contain a single variable domain(VHH) and two constant domains (CH2 and CH3). VHH is used to distinguishthem from the heavy chain variable domains that are present inconventional 4-chain antibodies (which are referred to as “VH domains”).The cloned and isolated VHH domain is a stable polypeptide harboring thefull antigen-binding capacity of the original heavy-chain antibody. VHHdomains and nanobodies can also be engineered into multivalent andmultispecific formats. Nanobodies with an amino acid sequence thatcorresponds to the amino acid sequence of a naturally occurring VHHdomain can be humanized, i.e. by replacing one or more amino acidresidues in the amino acid sequence of the naturally occurring VHHsequence (and in particular in the framework sequences) by one or moreof the amino acid residues that occur at the corresponding position(s)in a VH domain from a conventional 4-chain antibody from a human being.For details, see e.g., US 20050130266, US 20040253638, WO/2006/040153,US 20050214857, WO/2006/079372, or WO/2006/122825, each of which isincorporated herein by reference for all purposes. Antibodies against Aβcan also be produced via the Nanobody™ methods.

It is understood that any of the foregoing polypeptide molecules, aloneor in combination, are suitable for preparation as stabilizedformulations according to the invention.

Anti Aβ Antibodies

Generally, the formulations of the present invention include a varietyof antibodies for treating amyloidogenic diseases, in particular,Alzheimer's Disease, by targeting Aβ peptide.

The terms “Aβ antibody”, “anti Aβ antibody” and “anti Aβ” are usedinterchangeably herein to refer to an antibody that binds to one or moreepitopes or antigenic determinants of the human amyloid precursorprotein (APP), Aβ protein, or both. Exemplary epitopes or antigenicdeterminants can be found within APP, but are preferably found withinthe Aβ peptide of APP. Multiple isoforms of APP exist, for exampleAPP⁶⁹⁵, APP⁷⁵¹ and APP⁷⁷⁰. Amino acids within APP are assigned numbersaccording to the sequence of the APP⁷⁷⁰ isoform (see e.g., GenBankAccession No. P05067). Examples of specific isotypes of APP which arecurrently known to exist in humans are the 695 amino acid polypeptidedescribed by Kang et. al. (1987) Nature 325:733-736 which is designatedas the “normal” APP; the 751 amino acid polypeptide described by Ponteet al. (1988) Nature 331:525-527 (1988) and Tanzi et al. (1988) Nature331:528-530; and the 770-amino acid polypeptide described by Kitaguchiet. al. (1988) Nature 331:530-532. As a result of proteolytic processingof APP by different secretase enzymes in vivo or in situ, Aβ is found inboth a “short form”, 40 amino acids in length, and a “long form”,ranging from 42-43 amino acids in length. The short form, Aβ₄₀, consistsof residues 672-711 of APP. The long form, e.g., Aβ₄₂ or Aβ₄₃, consistsof residues 672-713 or 672-714, respectively. Part of the hydrophobicdomain of APP is found at the carboxy end of Aβ, and may account for theability of Aβ to aggregate, particularly in the case of the long form.Aβ peptide can be found in, or purified from, the body fluids of humansand other mammals, e.g. cerebrospinal fluid, including both normalindividuals and individuals suffering from amyloidogenic disorders.

The terms “β-amyloid protein”, “β-amyloid peptide”, “β-amyloid”, “Aβ”and “A β peptide” are used interchangeably herein. Aβ peptide (e.g.,Aβ39, Aβ40, Aβ41, Aβ42 and Aβ43) is a ˜4-kDa internal fragment of 39-43amino acids of APP. Aβ40, for example, consists of residues 672-711 ofAPP and Aβ42 consists of residues 672-713 of APP. Aβ peptides includepeptides resulting from secretase cleavage of APP and synthetic peptideshaving the same or essentially the same sequence as the cleavageproducts. Aβ peptides can be derived from a variety of sources, forexample, tissues, cell lines, or body fluids (e.g. sera or cerebrospinalfluid). For example, an Aβ can be derived from APP-expressing cells suchas Chinese hamster ovary (CHO) cells stably transfected withAPP_(717V→F), as described, for example, in Walsh et al., (2002),Nature, 416, pp 535-539. An Aβ preparation can be derived from tissuesources using methods previously described (see, e.g., Johnson-Wood etal., (1997), Proc. Natl. Acad. Sci. USA 94:1550). Alternatively, Aβpeptides can be synthesized using methods which are well known to thosein the art. See, for example, Fields et al., Synthetic Peptides: AUser's Guide, ed. Grant, W.H. Freeman & Co., New York, N.Y., 1992, p77). Hence, peptides can be synthesized using the automated Merrifieldtechniques of solid phase synthesis with the α-amino group protected byeither t-Boc or F-moc chemistry using side chain protected amino acidson, for example, an Applied Biosystems Peptide Synthesizer Model 430A or431. Longer peptide antigens can be synthesized using well knownrecombinant DNA techniques. For example, a polynucleotide encoding thepeptide or fusion peptide can be synthesized or molecularly cloned andinserted in a suitable expression vector for the transfection andheterologous expression by a suitable host cell. Aβ peptide also refersto related Aβ sequences that results from mutations in the Aβ region ofthe normal gene.

The terms “Aβ-derived diffusible ligand” and “ADDL” are small, solubleAβ42 oligomers, predominantly trimers and tetramers but alsohigher-order species (See e.g., Lambert, M. P. et al. (1998) Proc. Natl.Acad. Sci. USA, vol. 95, pp. 6448-6453; Chromy, B. A. et al. (2000) Soc.Neurosci. Abstr., vol. 26, p. 1284, WO 2004/031400, each of which isincorporated by reference in its entirety for all purposes.)

The term “anti-ADDL antibody” refers to an antibody that has beengenerated and selected for the ability to bind ADDLs specifically,without binding to Aβ monomer or amyloid fibrils. See e.g., WO2004/031400, incorporated by reference in its entirety for all purposes.

The term “epitope” or “antigenic determinant” refers to a site on anantigen to which an immunoglobulin or antibody (or antigen bindingfragment thereof) specifically binds. Exemplary epitopes or antigenicdeterminants to which an Aβ antibody binds can be found within the humanamyloid precursor protein (APP), but are preferably found within the Aβpeptide of APP. Exemplary epitopes or antigenic determinants within Aβare located within the N-terminus, central region, or C-terminus of Aβ.An “N-terminal epitope”, is an epitope or antigenic determinant locatedwithin the N-terminus of the Aβ peptide. Exemplary N-terminal epitopesinclude residues within amino acids 1-10 or 1-12 of Aβ, preferably fromresidues 1-3, 1-4, 1-5, 1-6, 1-7, 2-6, 2-7, 3-6, or 3-7 of Aβ42. Otherexemplary N-terminal epitopes start at residues 1-3 and end at residues7-11 of Aβ. Additional exemplary N-terminal epitopes include residues2-4, 5, 6, 7 or 8 of Aβ, residues 3-5, 6, 7, 8 or 9 of Aβ, or residues4-7, 8, 9 or 10 of Aβ42. “Central epitopes” are epitopes or antigenicdeterminants comprising residues located within the central ormid-portion of the Aβ peptide. Exemplary central epitopes includeresidues within amino acids 13-28 of Aβ, preferably from residues 14-27,15-26, 16-25, 17-24, 18-23, or 19-22 of Aβ. Other exemplary centralepitopes include residues within amino acids 16-24, 16-23, 16-22, 16-21,18-21, 19-21, 19-22, 19-23, or 19-24 of Aβ. “C-terminal” epitopes orantigenic determinants are located within the C-terminus of the Aβpeptide and include residues within amino acids 33-40, 33-41, or 33-42of Aβ. “C-terminal epitopes” are epitopes or antigenic determinantscomprising residues located within the C-terminus of the Aβ peptide(e.g., within about amino acids 30-40 or 30-42 of Aβ. Additionalexemplary C-terminal epitopes or antigenic determinants include residues33-40 or 33-42 of Aβ.

When an antibody is said to bind to an epitope within specifiedresidues, such as Aβ 3-7, what is meant is that the antibodyspecifically binds to a polypeptide containing the specified residues(i.e., Aβ 3-7 in this an example). Such an antibody does not necessarilycontact every residue within Aβ 3-7. Nor does every single amino acidsubstitution or deletion within Aβ 3-7 necessarily significantly affectbinding affinity.

In various aspects, an Aβ antibody is end-specific. As used herein, theterm “end-specific” refers to an antibody which specifically binds tothe N-terminal or C-terminal residues of an Aβ peptide but that does notrecognize the same residues when present in a longer Aβ speciescomprising the residues or in APP. In various aspects, an Aβ antibody is“C-terminus-specific.” As used herein, the term “C terminus-specific”means that the antibody specifically recognizes a free C-terminus of anAβ peptide. Examples of C terminus-specific Aβ antibodies include thosethat: recognize an Aβ peptide ending at residue 40 but do not recognizean Aβ peptide ending at residue 41, 42, and/or 43; recognize an Aβpeptide ending at residue 42 but do not recognize an Aβ peptide endingat residue 40, 41, and/or 43; etc.

In one aspect, the Aβ antibody may be a 3D6 antibody or variant thereof,or a 10D5 antibody or variant thereof, both of which are described inU.S. Patent Publication No. 20030165496A1, U.S. Patent Publication No.20040087777A1, International Patent Publication No. WO 02/46237A3 andInternational Patent Publication No. WO04/080419A2. Description of 3D6and 10D5 antibodies can also be found, for example, in InternationalPatent Publication No. WO02/088306A2 and International PatentPublication No. WO02/088307A2. 10D5 antibodies are also described inU.S. Patent Publication No. 20050142131. Additional 3D6 antibodies aredescribed in U.S. patent application Ser. No. 11/303,478 andInternational Application No. PCT/US05/45614. 3D6 is a monoclonalantibody (mAb) that specifically binds to an N-terminal epitope locatedin the human β-amyloid peptide, specifically, residues 1-5. Bycomparison, 10D5 is a mAb that specifically binds to an N-terminalepitope located in the human β-amyloid peptide, specifically, residues3-6. A cell line producing the 3D6 monoclonal antibody (RB96 3D6.32.2.4)was deposited with the American Type Culture Collection (ATCC),Manassas, Va. 20108, USA on Apr. 8, 2003 under the terms of the BudapestTreaty and has deposit number PTA-5130. A cell line producing the 10D5monoclonal antibody (RB44 10D5.19.21) was deposited with the ATCC onApr. 8, 2003 under the terms of the Budapest Treaty and has depositnumber PTA-5129.

Bapineuzumab means a humanized 3D6 antibody comprising a light chainhaving a mature variable region having the amino acid sequencedesignated SEQ ID NO: 1 and a heavy chain having a mature variableregion having the amino acid sequence designated SEQ ID NO: 2.

Humanized 3D6 Light Chain Variable Region (SEQ ID NO: 1)Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu ProVal Thr Pro Gly Glu Pro Ala Ser Ile Ser Cys LysSer Ser Gln Ser Leu Leu Asp Ser Asp Gly Lys ThrTyr Leu Asn Trp Leu Leu Gln Lys Pro Gly Gln SerPro Gln Arg Leu Ile Tyr Leu Val Ser Lys Leu AspSer Gly Val Pro Asp Arg Phe Ser Gly Ser Gly SerGly Thr Asp Phe Thr Leu Lys Ile Ser Arg Val GluAla Glu Asp Val Gly Val Tyr Tyr Cys Trp Gln GlyThr His Phe Pro Arg Thr Phe Gly Gln Gly Thr Lys Val Glu Ile LysHumanized 3D6 Heavy Chain Variable Region (SEQ ID NO: 2)Glu Val Gln Leu Leu Glu Ser Gly Gly Gly Leu ValGln Pro Gly Gly Ser Leu Arg Leu Ser Cys Ala AlaSer Gly Phe Thr Phe Ser Asn Tyr Gly Met Ser TrpVal Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp ValAla Ser Ile Arg Ser Gly Gly Gly Arg Thr Tyr TyrSer Asp Asn Val Lys Gly Arg Phe Thr Ile Ser ArgAsp Asn Ser Lys Asn Thr Leu Tyr Leu Gln Met AsnSer Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr CysVal Arg Tyr Asp His Tyr Ser Gly Ser Ser Asp TyrTrp Gly Gln Gly Thr Leu Val Thr Val Ser SerBapineuzumab is also known as AAB-001. FIG. 1 shows light and heavychain mature variable region amino acid sequences of Bapineuzumabpredicted from the expression construct DNA sequences. Amino acidsequence of the AAB-001 light and heavy chains predicted from theexpression construct DNA sequences. CDR regions are underlined.Cysteines expected to form intermolecular disulfide bonds are underlinedand the connectivity indicated. The N-linked glycosylation consensussite is in bold italics. The predicted heavy chain COOH-terminal lysineis shown in parenthesis.

A second version of humanized 3D6 antibody comprising a light chainhaving a mature variable region having the amino acid sequencedesignated SEQ ID NO: 3 and a heavy chain having a mature variableregion having the amino acid sequence designated SEQ ID NO: 4 is shownbelow.

Humanized 3D6 Light Chain Variable Region (SEQ ID NO: 3)Tyr Val Val Met Thr Gln Ser Pro Leu Ser Leu ProVal Thr Pro Gly Glu Pro Ala Ser Ile Ser Cys LysSer Ser Gln Ser Leu Leu Asp Ser Asp Gly Lys ThrTyr Leu Asn Trp Leu Leu Gln Lys Pro Gly Gln SerPro Gln Arg Leu Ile Tyr Leu Val Ser Lys Leu AspSer Gly Val Pro Asp Arg Phe Ser Gly Ser Gly SerGly Thr Asp Phe Thr Leu Lys Ile Ser Arg Val GluAla Glu Asp Val Gly Val Tyr Tyr Cys Trp Gln GlyThr His Phe Pro Arg Thr Phe Gly Gln Gly Thr Lys Val Glu Ile LysHumanized 3D6 Heavy Chain Variable Region (SEQ ID NO: 4)Glu Val Gln Leu Leu Glu Ser Gly Gly Gly Leu ValGln Pro Gly Gly Ser Leu Arg Leu Ser Cys Ala AlaSer Gly Phe Thr Phe Ser Asn Tyr Gly Met Ser TrpVal Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp ValAla Ser Ile Arg Ser Gly Gly Gly Arg Thr Tyr TyrSer Asp Asn Val Lys Gly Arg Phe Thr Ile Ser ArgAsp Asn Ala Lys Asn Ser Leu Tyr Leu Gln Met AsnSer Leu Arg Ala Glu Asp Thr Ala Leu Tyr Tyr CysVal Arg Tyr Asp His Tyr Ser Gly Ser Ser Asp TyrTrp Gly Gln Gly Thr Leu Val Thr Val Ser Ser

A third version of humanized 3D6 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 5 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 6 is describe in US2005/0090649 A1 published on Apr. 28, 2005, which is incorporated hereinby reference for all purposes.

Humanized 3D6 Light Chain (SEQ ID NO: 5)Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu ProVal Thr Leu Gly Gln Pro Ala Ser Ile Ser Cys LysSer Ser Gln Ser Leu Leu Asp Ser Asp Gly Lys ThrTyr Leu Asn Trp Leu Gln Gln Arg Pro Gly Gln SerPro Arg Arg Leu Ile Tyr Leu Val Ser Lys Leu AspSer Gly Val Pro Asp Arg Phe Ser Gly Ser Gly SerGly Thr Asp Phe Thr Leu Lys Ile Ser Arg Val GluAla Glu Asp Val Gly Val Tyr Tyr Cys Trp Gln GlyThr His Phe Pro Arg Thr Phe Gly Gly Gly Thr LysVal Glu Ile Lys Arg Thr Val Ala Ala Pro Ser ValPhe Ile Phe Pro Pro Ser Asp Glu Gln Leu Lys SerGly Thr Ala Ser Val Val Cys Leu Leu Asn Asn PheTyr Pro Arg Glu Ala Lys Val Gln Trp Lys Val AspAsn Ala Leu Gln Ser Gly Asn Ser Gln Glu Ser ValThr Glu Gln Asp Ser Lys Asp Ser Thr Tyr Ser LeuSer Ser Thr Leu Thr Leu Ser Lys Ala Asp Tyr GluLys His Lys Val Tyr Ala Cys Glu Val Thr His GlnGly Leu Ser Ser Pro Val Thr Lys Ser Phe Asn Arg Gly Glu CysHumanized 3D6 Heavy Chain (SEQ ID NO: 6)Gln Val Gln Leu Val Gln Ser Gly Gly Gly Leu ValGln Pro Gly Gly Ser Leu Arg Leu Ser Cys Ala GlySer Gly Phe Thr Phe Ser Asn Tyr Gly Met Ser TrpVal Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp ValAla Ser Ile Arg Ser Gly Gly Gly Arg Thr Tyr TyrSer Asp Asn Val Lys Gly Arg Phe Thr Ile Ser ArgGlu Asn Ala Lys Asn Ser Leu Tyr Leu Gln Met AsnSer Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr CysVal Arg Tyr Asp His Tyr Ser Gly Ser Ser Asp TyrTrp Gly Gln Gly Thr Leu Val Thr Val Ser Ser AlaSer Thr Lys Gly Pro Ser Val Phe Pro Leu Ala ProSer Ser Lys Ser Thr Ser Gly Gly Thr Ala Ala LeuGly Cys Leu Val Lys Asp Tyr Phe Pro Gln Pro ValThr Val Ser Trp Asn Ser Gly Ala Leu Thr Ser GlyVal His Thr Phe Pro Ala Val Leu Gln Ser Ser GlyLeu Tyr Ser Leu Ser Ser Val Val Thr Val Pro SerSer Ser Leu Gly Thr Gln Thr Tyr Ile Cys Asn ValAsn His Lys Pro Ser Asn Thr Lys Val Asp Lys LysVal Glu Pro Lys Ser Cys Asp Lys Thr His Thr CysPro Pro Cys Pro Ala Pro Gln Leu Leu Gly Gly ProSer Val Phe Leu Phe Pro Pro Lys Pro Lys Asp ThrLeu Met Ile Ser Arg Thr Pro Glu Val Thr Cys ValVal Val Asp Val Ser His Glu Asp Pro Glu Val LysPhe Asn Trp Tyr Val Asp Gly Val Glu Val His AsnAla Lys Thr Lys Pro Arg Glu Glu Gln Tyr Asn SerThr Tyr Arg Val Val Ser Val Leu Thr Val Leu HisGln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys LysVal Ser Asn Lys Ala Leu Pro Ala Pro Ile Glu LysThr Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu ProGln Val Tyr Thr Leu Pro Pro Ser Arg Asp Glu LeuThr Lys Asn Gln Val Ser Leu Thr Cys Leu Val LysGly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp GluSer Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr ThrPro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe LeuTyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp GlnGln Gly Asn Val Phe Ser Cys Ser Val Met His GluAla Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys

A version of humanized 10D5 antibody comprising a light chain having amature variable region having the amino acid sequence designated SEQ IDNO: 28 and a heavy chain having a mature variable region having theamino acid sequence designated SEQ ID NO: 29 is shown below.

Humanized 10D5 Light Chain Variable Region (SEQ ID NO: 28)Asp Val Leu Met Thr Gln Thr Pro Leu Ser Leu ProVal Ser Leu Gly Asp Gln Ala Ser Ile Ser Cys ArgSer Ser Gln Asn Ile Ile His Ser Asn Gly Asn ThrTyr Leu Glu Trp Tyr Leu Gln Lys Pro Gly Gln SerPro Lys Leu Leu Ile Tyr Lys Val Ser Asn Arg PheSer Gly Val Pro Asp Arg Phe Ser Gly Ser Gly SerGly Thr Asp Phe Thr Leu Lys Ile Lys Lys Val GluAla Glu Asp Leu Gly Ile Tyr Tyr Cys Phe Gln GlySer His Val Pro Leu Thr Phe Gly Ala Gly Thr Lys Leu Glu Leu GluHumanized 10D5 Heavy Chain Variable Region (SEQ ID NO: 29)Gln Ala Thr Leu Lys Glu Ser Gly Pro Gly Ile LeuGln Ser Ser Gln Thr Leu Ser Leu Thr Cys Ser PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Gly ValSer Trp Ile Arg Gln Pro Ser Gly Lys Gly Leu GluTrp Leu Ala His Ile Tyr Trp Asp Asp Asp Lys ArgTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Arg Lys Gln Val Phe Leu Lys IleThr Ser Val Asp Pro Ala Asp Thr Ala Thr Tyr TyrCys Val Arg Arg Pro Ile Thr Pro Val Leu Val AspAla Met Asp Tyr Trp Gly Gln Gly Thr Ser Val Thr Val Ser Ser

In another aspect, the antibody may be a 12B4 antibody or variantthereof, as described in U.S. Patent Publication No. 20040082762A1 andInternational Patent Publication No. WO 03/077858A2. 12B4 is a mAb thatspecifically binds to an N-terminal epitope located in the humanβ-amyloid peptide, specifically, residues 3-7.

12A11 or a chimeric or humanized or nanobody form thereof is a preferredantibody. The 12A11 antibody or a variant thereof, is described in U.S.Patent Publication No. 20050118651, U.S. Patent Publication No.20060198851, International Patent Publication No. WO 04/108895, andInternational Patent Publication No. WO 06/066089, all of which areincorporated by reference in their entirety herein for all purposes.12A11 is a mAb that specifically binds to an N-terminal epitope locatedin the human β-amyloid peptide, specifically, residues 3-7. A cell lineproducing the 12A11 monoclonal antibody was deposited at the ATCC(American Type Culture Collection, 10801 University Boulevard, Manassas,Va. 20110-2209) on Dec. 12, 2005 and has the ATCC accession numberPTA-7271.

A first version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 8 (version 1) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Light Chain (SEQ ID NO: 7)Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu ProVal Thr Pro Gly Glu Pro Ala Ser Ile Ser Cys ArgSer Ser Gln Ser Ile Val His Ser Asn Gly Asn ThrTyr Leu Glu Trp Tyr Leu Gln Lys Pro Gly Gln SerPro Gln Leu Leu Ile Tyr Lys Val Ser Asn Arg PheSer Gly Val Pro Asp Arg Phe Ser Gly Ser Gly SerGly Thr Asp Phe Thr Leu Lys Ile Ser Arg Val GluAla Glu Asp Val Gly Val Tyr Tyr Cys Phe Gln SerSer His Val Pro Leu Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile LysHumanized 12A11 Heavy Chain (version 1) (SEQ ID NO: 8)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A second version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 9 (version 2)is described in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 2) (SEQ ID No: 9)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A third version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 10 (version 2.1) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 2.1) (SEQ ID NO: 10)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Asn Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A fourth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 11 (version3) is described in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 3) (SEQ ID NO: 11)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Set Arg Phe Thr Ile SerArg Asp Asn Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asn Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A fifth version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 12 (version 4.1) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 4.1) (SEQ ID NO: 12)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A sixth version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 13 (version 4.2) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 4.2) (SEQ ID NO: 13)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

An seventh version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 14 (version4.3) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 4.3) (SEQ ID NO: 14)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A eighth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 15 (version4.4) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 4.4) (SEQ ID NO: 15)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A ninth version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 16 (version 5.1) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.1) (SEQ ID NO: 16)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A tenth version of the humanized 12A11 antibody comprising a light chainhaving the amino acid sequence designated SEQ ID NO: 7 and a heavy chainhaving the amino acid sequence designated SEQ ID NO: 17 (version 5.2) isdescribed in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.2) (SEQ ID NO: 17)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

An eleventh version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 18 (version5.3) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.3) (SEQ ID NO: 18)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser Val

A twelfth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 19 (version5.4) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.4) (SEQ ID NO: 19)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser Val

A thirteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 20 (version5.5) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.5) (SEQ ID NO: 20)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A fourteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 21 (version5.6) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 5.6) (SEQ ID NO: 21)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A fifteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 22 (version6.1) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 6.1) (SEQ ID NO: 22)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A sixteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 23 (version6.2) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 6.2) (SEQ ID NO: 23)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A seventeenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 24 (version6.3) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 6.3) (SEQ ID NO: 24)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A eighteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 25 (version6.4) is described in US 20050118651 A1 published on Jun. 2, 2005, whichis incorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 6.4) (SEQ ID NO: 25)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Val Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Phe Thr Ile SerLys Asp Thr Ser Lys Asn Thr Leu Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe Ala Tyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A nineteenth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 26 (version7) is described in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 7) (SEQ ID NO: 26)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Thr Leu Ser Thr Ser Gly Met Ser ValGly Trp Val Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Thr Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

A twentieth version of the humanized 12A11 antibody comprising a lightchain having the amino acid sequence designated SEQ ID NO: 7 and a heavychain having the amino acid sequence designated SEQ ID NO: 27 (version8) is described in US 20050118651 A1 published on Jun. 2, 2005, which isincorporated herein by reference for all purposes.

Humanized 12A11 Heavy Chain (version 27) (SEQ ID NO: 8)Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val ValGln Pro Gly Arg Ser Leu Arg Leu Ser Cys Ala PheSer Gly Phe Ser Leu Ser Thr Ser Gly Met Ser ValGly Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu GluTrp Leu Ala His Ile Trp Trp Asp Asp Asp Lys TyrTyr Asn Pro Ser Leu Lys Ser Arg Leu Thr Ile SerLys Asp Asn Ser Lys Asn Thr Val Tyr Leu Gln MetAsn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr TyrCys Ala Arg Arg Thr Thr Thr Ala Asp Tyr Phe AlaTyr Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser

In yet another aspect, the antibody may be a 6C6 antibody, or a variantthereof, as described in a U.S. Patent Publication No. US 20060165682and International Patent Publication No. WO 06/06604 entitled “HumanizedAntibodies that Recognize Beta Amyloid Peptide.” 6C6 is a mAb thatspecifically binds to an N-terminal epitope located in the humanβ-amyloid peptide, specifically, residues 3-7. A cell line producing theantibody 6C6 was deposited on Nov. 1, 2005, with the ATCC under theterms of the Budapest Treaty and assigned accession number PTA-7200.

In yet another aspect, the antibody may be a 2H3 antibody as describedin U.S. Patent Publication US 20060257396. 2H3 is a mAb thatspecifically binds to an N-terminal epitope located in the humanβ-amyloid peptide, specifically, residues 2-7. A cell line producing theantibody 2H3 was deposited on Dec. 13, 2005, with the ATCC under theterms of the Budapest Treaty and assigned accession number PTA-7267.

In yet another aspect, the antibody may be a 3A3 antibody as describedin U.S. Patent Publication US 20060257396. 3A3 is a mAb thatspecifically binds to an N-terminal epitope located in the humanβ-amyloid peptide, specifically, residues 3-7. A cell line producing theantibody 3A3 was deposited on Dec. 13, 2005, with the ATCC under theterms of the Budapest Treaty and assigned accession number PTA-7269.

In yet another aspect, the antibody may be 2B1, 1C2 or 9G8. Cell linesproducing the antibodies 2B1, 1C2 and 9G8 were deposited on Nov. 1,2005, with the ATCC under the terms of the Budapest Treaty and wereassigned accession numbers PTA-7202, PTA-7199 and PTA-7201,respectively.

Antibodies for use in the present invention may be recombinantly orsynthetically produced. For example, the antibody may be produced by arecombinant cell culture process, using, e.g., CHO cells, NIH 3T3 cells,PER.C6® cells, NS0 cells, VERO cells, chick embryo fibroblasts, or BHKcells. In addition, antibodies with minor modifications that retain theprimary functional property of binding Aβ peptide are contemplated bythe present invention. In a particular aspect, the antibody is ahumanized anti Aβ peptide 3D6 antibody that selectively binds Aβpeptide. More specifically, the humanized anti Aβ peptide 3D6 antibodyis designed to specifically bind to an NH₂-terminal epitope, forexample, amino acid residues 1-5, located in the human β-amyloid 1-40 or1-42 peptide found in plaque deposits in the brain (e.g., in patientssuffering from Alzheimer's disease).

Prophylactic and Therapeutic Methods

The present invention is directed inter alia to treatment of Alzheimer'sand other amyloidogenic diseases by administration of therapeuticimmunological reagents (e.g., humanized immunoglobulins) to specificepitopes within Aβ to a patient under conditions that generate abeneficial therapeutic response in a patient (e.g., induction ofphagocytosis of Aβ, reduction of plaque burden, inhibition of plaqueformation, reduction of neuritic dystrophy, improving cognitivefunction, and/or reversing, treating or preventing cognitive decline) inthe patient, for example, for the prevention or treatment of anamyloidogenic disease. The invention is also directed to use of thedisclosed immunological reagents (e.g., humanized immunoglobulins) inthe manufacture of a medicament for the treatment or prevention of anamyloidogenic disease.

The term “treatment” as used herein, is defined as the application oradministration of a therapeutic agent to a patient, or application oradministration of a therapeutic agent to an isolated tissue or cell linefrom a patient, who has a disease, a symptom of disease or apredisposition toward a disease, with the purpose to cure, heal,alleviate, relieve, alter, remedy, ameliorate, improve or affect thedisease, the symptoms of disease or the predisposition toward disease.

In one aspect, the invention provides methods of preventing or treatinga disease associated with amyloid deposits of Aβ in the brain of apatient. Such diseases include Alzheimer's disease, Down's syndrome andcognitive impairment. The latter can occur with or without othercharacteristics of an amyloidogenic disease. Some methods of theinvention entail administering an effective dosage of an antibody thatspecifically binds to a component of an amyloid deposit to the patient.Such methods are particularly useful for preventing or treatingAlzheimer's disease in human patients. Exemplary methods entailadministering an effective dosage of an antibody that binds to Aβ.Preferred methods entail administering an effective dosage of anantibody that specifically binds to an epitope within residues 1-10 ofAβ, for example, antibodies that specifically bind to an epitope withinresidues 1-3 of Aβ, antibodies that specifically bind to an epitopewithin residues 1-4 of Aβ, antibodies that specifically bind to anepitope within residues 1-5 of Aβ, antibodies that specifically bind toan epitope within residues 1-6 of Aβ, antibodies that specifically bindto an epitope within residues 1-7 of Aβ, or antibodies that specificallybind to an epitope within residues 3-7 of Aβ. In yet another aspect, theinvention features administering antibodies that bind to an epitopecomprising a free N-terminal residue of Aβ. In yet another aspect, theinvention features administering antibodies that bind to an epitopewithin residues of 1-10 of Aβ wherein residue 1 and/or residue 7 of Aβis aspartic acid. In yet another aspect, the invention featuresadministering antibodies that specifically bind to Aβ peptide withoutbinding to full-length amyloid precursor protein (APP). In yet anotheraspect, the isotype of the antibody is human IgG1.

In yet another aspect, the invention features administering antibodiesthat bind to an amyloid deposit in the patient and induce a clearingresponse against the amyloid deposit. For example, such a clearingresponse can be effected by Fc receptor mediated phagocytosis.

Therapeutic agents of the invention are typically substantially purefrom undesired contaminant. This means that an agent is typically atleast about 50% w/w (weight/weight) purity, as well as beingsubstantially free from interfering proteins and contaminants. Sometimesthe agents are at least about 80% w/w and, more preferably at least 90or about 95% w/w purity. However, using conventional proteinpurification techniques, homogeneous peptides of at least 99% w/w can beobtained.

The methods can be used on both asymptomatic patients and thosecurrently showing symptoms of disease. The antibodies used in suchmethods can be human, humanized, chimeric or nonhuman antibodies, orfragments thereof (e.g., antigen binding fragments) and can bemonoclonal or polyclonal, as described herein. In yet another aspect,the invention features administering antibodies prepared from a humanimmunized with Aβ peptide, which human can be the patient to be treatedwith antibody.

In another aspect, the invention features administering an antibody witha pharmaceutical carrier as a pharmaceutical composition. Alternatively,the antibody can be administered to a patient by administering apolynucleotide encoding at least one antibody chain. The polynucleotideis expressed to produce the antibody chain in the patient. Optionally,the polynucleotide encodes heavy and light chains of the antibody. Thepolynucleotide is expressed to produce the heavy and light chains in thepatient. In other aspects, the patient is monitored for level ofadministered antibody in the blood of the patient.

The invention thus fulfills a longstanding need for therapeutic regimesfor preventing or ameliorating the neuropathology and, in some patients,the cognitive impairment associated with Alzheimer's disease.

Patients Amenable to Treatment

Patients amenable to treatment include individuals at risk of diseasebut not showing symptoms, as well as patients presently showingsymptoms. In the case of Alzheimer's disease, virtually anyone is atrisk of suffering from Alzheimer's disease if he or she lives longenough. Therefore, the present methods can be administeredprophylactically to the general population without the need for anyassessment of the risk of the subject patient. The present methods areespecially useful for individuals who have a known genetic risk ofAlzheimer's disease. Such individuals include those having relatives whohave experienced this disease, and those whose risk is determined byanalysis of genetic or biochemical markers. Genetic markers of risktoward Alzheimer's disease include mutations in the APP gene,particularly mutations at position 717 and positions 670 and 671referred to as the Hardy and Swedish mutations respectively (see Hardy,supra). Other markers of risk are mutations in the presenilin genes, PS1and PS2, and ApoE4, family history of AD, hypercholesterolemia oratherosclerosis. Individuals presently suffering from Alzheimer'sdisease can be recognized from characteristic dementia, as well as thepresence of risk factors described above. In addition, a number ofdiagnostic tests are available for identifying individuals who have AD.These include measurement of CSF tau and Aβ42 levels. Elevated tau anddecreased Aβ42 levels signify the presence of AD. Individuals sufferingfrom Alzheimer's disease can also be diagnosed by ADRDA criteria asdiscussed in the Examples section.

In asymptomatic patients, treatment can begin at any age (e.g., 10, 20,30). Usually, however, it is not necessary to begin treatment until apatient reaches 40, 50, 60 or 70. Treatment typically entails multipledosages over a period of time. Treatment can be monitored by assayingantibody levels over time. If the response falls, a booster dosage isindicated. In the case of potential Down's syndrome patients, treatmentcan begin antenatally by administering therapeutic agent to the motheror shortly after birth.

Patients amenable to treatment include patients 50 to 87 years of age,patients suffering from mild to moderate Alzheimer's disease, patientshaving an MMSE score of 14-26, patients having a diagnosis of probableAlzheimer's disease based on Neurological and Communicative Disordersand Stroke-Alzheimer's disease Related Disorders (NINCDS-ADRDA)criteria, and/or patients having an Rosen Modified Hachinski Ischemicscore less than or equal to 4. Patients with MRI an scan consistent withthe diagnosis of Alzheimer's disease, i.e., that there are no otherabnormalities present on the MRI that could be attributed to otherdiseases, e.g. stroke, traumatic brain injury, arachnoid cysts, tumors,etc are also amendable to treatment.

The methods of the invention are particular amendable for patients thathave no history or evidence of any of the following: encephalitis;clinically evident stroke; clinically significant carotid orvertebrobasilar stenosis or plaque; seizures, excluding febrile seizuresin childhood; any significant autoimmune disease or disorder of theimmune system; and/or clinically significant renal disorder. The methodsof the invention are particular amendable for patients that have had noclinically significant infection within the 30 days before treatmentcommences, e.g., a chronic persistent or acute infection. The methods ofthe invention are particular amendable for patients that have not beentreated with immunosuppressive medication (e.g., systemiccorticosteroids) within 90 days before treatment commences (topical andnasal corticosteroids and inhaled corticosteroids for asthma arepermitted) or chemotherapeutic agents for malignancy within 3 yearsbefore treatment commences. The methods of the invention are alsoparticular amendable for patients that have no clinically significantabnormality on physical, neurological, laboratory, or EKG examination(e.g. atrial fibrillation) if the abnormality could be detrimental tothe patient. The methods of the invention are also particular amendablefor patients that do not use anticonvulsants for seizure,anti-Parkinson's, anticoagulant (excluding the use of aspirin 325 mg/dayor less), or narcotic medications.

Treatment Regimes and Dosages

In prophylactic applications, pharmaceutical compositions or medicamentsare administered to a patient susceptible to, or otherwise at risk of,Alzheimer's disease in an amount sufficient to eliminate or reduce therisk, lessen the severity, or delay the outset of the disease, includingbiochemical, histologic and/or behavioral symptoms of the disease, itscomplications and intermediate pathological phenotypes presenting duringdevelopment of the disease. In therapeutic applications, compositions ormedicants are administered to a patient suspected of, or alreadysuffering from such a disease in an amount sufficient to cure, or atleast partially arrest, the symptoms of the disease (biochemical,histologic and/or behavioral), including its complications andintermediate pathological phenotypes in development of the disease.

In some methods, administration of agent reduces or eliminatesmyocognitive impairment in patients that have not yet developedcharacteristic Alzheimer's pathology. An amount adequate to accomplishtherapeutic or prophylactic treatment is defined as a therapeutically-or prophylactically-effective dose. In both prophylactic and therapeuticregimes, agents are usually administered in several dosages until asufficient immune response has been achieved. The term “immune response”or “immunological response” includes the development of a humoral(antibody mediated) and/or a cellular (mediated by antigen-specific Tcells or their secretion products) response directed against an antigenin a recipient subject. Such a response can be an active response, i.e.,induced by administration of immunogen, or a passive response, i.e.,induced by administration of immunoglobulin or antibody or primedT-cells.

An “immunogenic agent” or “immunogen” is capable of inducing animmunological response against itself on administration to a mammal,optionally in conjunction with an adjuvant. Typically, the immuneresponse is monitored and repeated dosages are given if the immuneresponse starts to wane.

Effective doses of the compositions of the present invention, for thetreatment of the above described conditions vary depending upon manydifferent factors, including means of administration, target site,physiological state of the patient, whether the patient is human or ananimal, other medications administered, and whether treatment isprophylactic or therapeutic. Usually, the patient is a human butnon-human mammals including transgenic mammals can also be treated.Treatment dosages need to be titrated to optimize safety and efficacy.

For passive immunization, the dosage ranges from about 0.0001 to 100,and more usually 0.01 to 5 mg/kg of the host body weight. For example,dosage ranges can be less than 20 mg/kg body weight or 10 mg/kg bodyweight or within the range of 1.0 to 7 mg/kg. For passive immunization,the preferred dosage ranges from about 0.5 to less than 5 mg/kg, andmore usually 0.5 to 3 mg/kg, of the host body weight. For exampledosages can be less than 5 mg/kg body weight or 1.5 mg/kg body weight orwithin the range of 0.5 to 1.5 mg/kg, preferably at least 1.5 mg/kg.Subjects can be administered such doses daily, on alternative days,weekly or according to any other schedule determined by empiricalanalysis. An exemplary treatment entails administration in multipledosages over a prolonged period, for example, of at least six months.Additional exemplary treatment regimes entail administration once perevery two weeks or once a month or once every 3 to 6 months.

Exemplary passive dosage schedules include 1.5-3 mg/kg or 1.5 mg/kgevery thirteen weeks. Agents of the invention are usually administeredon multiple occasions. Intervals between single dosages can be weekly,monthly, every thirteen weeks, or yearly. Intervals can also beirregular as indicated by measuring blood levels of antibody to Aβ inthe patient.

In some methods, dosage is adjusted to achieve a plasma antibodyconcentration of 1-1000 μg/ml and in some methods 25-300 μg/ml.Alternatively, antibody can be administered as a sustained releaseformulation, in which case less frequent administration is required.Dosage and frequency vary depending on the half-life of the antibody inthe patient. In general, human antibodies show the longest half-life,followed by humanized antibodies, chimeric antibodies, and nonhumanantibodies.

The dosage and frequency of administration can vary depending on whetherthe treatment is prophylactic or therapeutic. In prophylacticapplications, compositions containing the present antibodies or acocktail thereof are administered to a patient not already in thedisease state to enhance the patient's resistance. Such an amount isdefined to be a “prophylactic effective dose.” In this use, the preciseamounts again depend upon the patient's state of health and generalimmunity, but generally range from 0.1 to 25 mg per dose, especially 0.5to 2.5 mg per dose. A relatively low dosage is administered atrelatively infrequent intervals over a long period of time. Somepatients continue to receive treatment for the rest of their lives.

In therapeutic applications, a relatively high dosage (e.g., from about10 to 250 mg of antibody per dose, with dosages of from 5 to 25 mg beingmore commonly used) at relatively short intervals is sometimes requireduntil progression of the disease is reduced or terminated, andpreferably until the patient shows partial or complete amelioration ofsymptoms of disease. Thereafter, the patent can be administered aprophylactic regime.

Therapeutic agents can be administered by parenteral, topical,intravenous, oral, subcutaneous, intraarterial, intracranial,intraperitoneal, intranasal or intramuscular means for prophylacticand/or therapeutic treatment. The most typical route of administrationof a passive immunogenic agent is intravenous infusion although otherroutes can be equally effective. The next most common route isintramuscular injection. This type of injection is most typicallyperformed in the arm or leg muscles. In some methods, agents areinjected directly into a particular tissue where deposits haveaccumulated, for example intracranial injection. Intramuscular injectionor intravenous infusion are preferred for administration of antibody. Insome methods, particular therapeutic antibodies are injected directlyinto the cranium. In some methods, antibodies are administered as asustained release composition or device, such as a Medipad™ device.

Agents of the invention can optionally be administered in combinationwith other agents that are at least partly effective in treatment ofamyloidogenic disease. In the case of Alzheimer's and Down's syndrome,in which amyloid deposits occur in the brain, agents of the inventioncan also be administered in conjunction with other agents that increasepassage of the agents of the invention across the blood-brain barrier.

Pharmaceutical Compositions

Agents of the invention are often administered as pharmaceuticalcompositions comprising an active therapeutic agent, i.e., and a varietyof other pharmaceutically acceptable components. See Remington'sPharmaceutical Science (15th ed., Mack Publishing Company, Easton, Pa.(1980)). The preferred form depends on the intended mode ofadministration and therapeutic application. The compositions can alsoinclude, depending on the formulation desired,pharmaceutically-acceptable, non-toxic carriers or diluents, which aredefined as vehicles commonly used to formulate pharmaceuticalcompositions for animal or human administration. The diluent is selectedso as not to affect the biological activity of the combination. Examplesof such diluents are distilled water, physiological phosphate-bufferedsaline, Ringer's solutions, dextrose solution, and Hank's solution. Inaddition, the pharmaceutical composition or formulation may also includeother carriers, adjuvants, or nontoxic, nontherapeutic, nonimmunogenicstabilizers and the like.

Pharmaceutical compositions can also include large, slowly metabolizedmacromolecules such as proteins, polysaccharides such as chitosan,polylactic acids, polyglycolic acids and copolymers (such as latexfunctionalized Sepharose™, agarose, cellulose, and the like), polymericamino acids, amino acid copolymers, and lipid aggregates (such as oildroplets or liposomes). Additionally, these carriers can function asimmuno stimulating agents (i.e., adjuvants).

For parenteral administration, agents of the invention can beadministered as injectable dosages of a solution or suspension of thesubstance in a physiologically acceptable diluent with a pharmaceuticalcarrier that can be a sterile liquid such as water oils, saline,glycerol, or ethanol. Additionally, auxiliary substances, such aswetting or emulsifying agents, surfactants, pH buffering substances andthe like can be present in compositions. Other components ofpharmaceutical compositions are those of petroleum, animal, vegetable,or synthetic origin, for example, peanut oil, soybean oil, and mineraloil. In general, glycols such as propylene glycol or polyethylene glycolare preferred liquid carriers, particularly for injectable solutions.Antibodies can be administered in the form of a depot injection orimplant preparation, which can be formulated in such a manner as topermit a sustained release of the active ingredient. An exemplarycomposition comprises monoclonal antibody at 5 mg/mL, formulated inaqueous buffer consisting of 50 mM L-histidine, 150 mM NaCl, adjusted topH 6.0 with HCl.

Typically, compositions are prepared as injectables, either as liquidsolutions or suspensions; solid forms suitable for solution in, orsuspension in, liquid vehicles prior to injection can also be prepared.The preparation also can be emulsified or encapsulated in liposomes ormicro particles such as polylactide, polyglycolide, or copolymer forenhanced adjuvant effect, as discussed above (see Langer, Science 249:1527 (1990) and Hanes, Advanced Drug Delivery Reviews 28:97 (1997)). Theagents of this invention can be administered in the form of a depotinjection or implant preparation, which can be formulated in such amanner as to permit a sustained or pulsatile release of the activeingredient.

Additional formulations suitable for other modes of administrationinclude oral, intranasal, and pulmonary formulations, suppositories, andtransdermal applications. For suppositories, binders and carriersinclude, for example, polyalkylene glycols or triglycerides; suchsuppositories can be formed from mixtures containing the activeingredient in the range of 0.5% to 10%, preferably 1%-2%. Oralformulations include excipients, such as pharmaceutical grades ofmannitol, lactose, starch, magnesium stearate, sodium saccharine,cellulose, and magnesium carbonate. These compositions take the form ofsolutions, suspensions, tablets, pills, capsules, sustained releaseformulations or powders and contain 10%-95% of active ingredient,preferably 25%-70%.

Topical application can result in transdermal or intradermal delivery.Topical administration can be facilitated by co-administration of theagent with cholera toxin or detoxified derivatives or subunits thereofor other similar bacterial toxins (See Glenn et al., Nature 391, 851(1998)). Co-administration can be achieved by using the components as amixture or as linked molecules obtained by chemical crosslinking orexpression as a fusion protein.

Alternatively, transdermal delivery can be achieved using a skin path orusing transferosomes (Paul et al., Eur. J. Immunol. 25:3521 (1995); Cevcet al., Biochem. Biophys. Acta 1368:201-15 (1998)).

Monitoring the Course of Treatment

The invention provides methods of monitoring treatment in a patientsuffering from or susceptible to Alzheimer's, i.e., for monitoring acourse of treatment being administered to a patient. The methods can beused to monitor both therapeutic treatment on symptomatic patients andprophylactic treatment on asymptomatic patients. In particular, themethods are useful for monitoring passive immunization (e.g., measuringlevel of administered antibody).

Some methods entail determining a baseline value, for example, of anantibody level or profile in a patient, before administering a dosage ofagent, and comparing this with a value for the profile or level aftertreatment. A significant increase (i.e., greater than the typical marginof experimental error in repeat measurements of the same sample,expressed as one standard deviation from the mean of such measurements)in value of the level or profile signals a positive treatment outcome(i.e., that administration of the agent has achieved a desiredresponse). If the value for immune response does not changesignificantly, or decreases, a negative treatment outcome is indicated.

In other methods, a control value (i.e., a mean and standard deviation)of level or profile is determined for a control population. Typicallythe individuals in the control population have not received priortreatment. Measured values of the level or profile in a patient afteradministering a therapeutic agent are then compared with the controlvalue. A significant increase relative to the control value (e.g.,greater than one standard deviation from the mean) signals a positive orsufficient treatment outcome. A lack of significant increase or adecrease signals a negative or insufficient treatment outcome.Administration of agent is generally continued while the level isincreasing relative to the control value. As before, attainment of aplateau relative to control values is an indicator that theadministration of treatment can be discontinued or reduced in dosageand/or frequency.

In other methods, a control value of the level or profile (e.g., a meanand standard deviation) is determined from a control population ofindividuals who have undergone treatment with a therapeutic agent andwhose levels or profiles have reached a plateau in response totreatment. Measured values of levels or profiles in a patient arecompared with the control value. If the measured level in a patient isnot significantly different (e.g., more than one standard deviation)from the control value, treatment can be discontinued. If the level in apatient is significantly below the control value, continuedadministration of agent is warranted. If the level in the patientpersists below the control value, then a change in treatment may beindicated.

In other methods, a patient who is not presently receiving treatment buthas undergone a previous course of treatment is monitored for antibodylevels or profiles to determine whether a resumption of treatment isrequired. The measured level or profile in the patient can be comparedwith a value previously achieved in the patient after a previous courseof treatment. A significant decrease relative to the previousmeasurement (i.e., greater than a typical margin of error in repeatmeasurements of the same sample) is an indication that treatment can beresumed. Alternatively, the value measured in a patient can be comparedwith a control value (mean plus standard deviation) determined in apopulation of patients after undergoing a course of treatment.Alternatively, the measured value in a patient can be compared with acontrol value in populations of prophylactically treated patients whoremain free of symptoms of disease, or populations of therapeuticallytreated patients who show amelioration of disease characteristics. Inall of these cases, a significant decrease relative to the control level(i.e., more than a standard deviation) is an indicator that treatmentshould be resumed in a patient.

The tissue sample for analysis is typically blood, plasma, serum, mucousfluid or cerebrospinal fluid from the patient. The sample is analyzed,for example, for levels or profiles of antibodies to Aβ peptide, e.g.,levels or profiles of humanized antibodies. ELISA methods of detectingantibodies specific to Aβ are described in the Examples section. In somemethods, the level or profile of an administered antibody is determinedusing a clearing assay, for example, in an in vitro phagocytosis assay,as described herein. In such methods, a tissue sample from a patientbeing tested is contacted with amyloid deposits (e.g., from a PDAPPmouse) and phagocytic cells bearing Fc receptors. Subsequent clearing ofthe amyloid deposit is then monitored. The existence and extent ofclearing response provides an indication of the existence and level ofantibodies effective to clear Aβ in the tissue sample of the patientunder test.

The antibody profile following passive immunization typically shows animmediate peak in antibody concentration followed by an exponentialdecay. Without a further dosage, the decay approaches pretreatmentlevels within a period of days to months depending on the half-life ofthe antibody administered. For example the half-life of some humanantibodies is of the order of 20 days.

In some methods, a baseline measurement of antibody to Aβ in the patientis made before administration, a second measurement is made soonthereafter to determine the peak antibody level, and one or more furthermeasurements are made at intervals to monitor decay of antibody levels.When the level of antibody has declined to baseline or a predeterminedpercentage of the peak less baseline (e.g., 50%, 25% or 10%),administration of a further dosage of antibody is administered. In somemethods, peak or subsequent measured levels less background are comparedwith reference levels previously determined to constitute a beneficialprophylactic or therapeutic treatment regime in other patients. If themeasured antibody level is significantly less than a reference level(e.g., less than the mean minus one standard deviation of the referencevalue in population of patients benefiting from treatment)administration of an additional dosage of antibody is indicated.

Additional methods include monitoring, over the course of treatment, anyart-recognized physiologic symptom (e.g., physical or mental symptom)routinely relied on by researchers or physicians to diagnose or monitoramyloidogenic diseases (e.g., Alzheimer's disease). For example, one canmonitor cognitive impairment. The latter is a symptom of Alzheimer'sdisease and Down's syndrome but can also occur without othercharacteristics of either of these diseases. For example, cognitiveimpairment can be monitored by determining a patient's score on theMini-Mental State Exam in accordance with convention throughout thecourse of treatment.

The patient may be monitored by at least one type of assessment selectedfrom the group of consisting of Mini-Mental State Exam (MMSE),Alzheimer's Disease Assessment Scale—cognitive (ADAS-COG), ClinicianInterview-Based Impression (CIBI), Neurological Test Battery (NTB),Disability Assessment for Dementia (DAD), Clinical Dementia Rating-sumof boxes (CDR-SOB), Neuropsychiatric Inventory (NPI), Positron EmissionTomography (PET Imaging) scan, Magnetic Resonance Imaging (MRI) scan, anEKG and measurement of blood pressure. The type of assessment may beadministered on multiple occasions. For example, an MMSE may beperformed before administering a dosage of the immunogenic agent, and atweek 4, week 6, week 16, 6 months, and 1 year after administering thedosage of the immunogenic agent. In some patients an MMSE may beperformed before administering a dosage of the immunogenic agent, and atweek 6, and week 16. An MRI scan may be performed every 3 months, every6 months, or every year.

Patients may be monitored for posterior reversible encephalopathysyndrome (PRES) or vascular edema after administration of an antibodywithin a range of about 0.5 mg/kg to less than 5 mg/kg, wherein theantibody specifically binds to beta amyloid peptide (Aβ) with a bindingaffinity of at least 10⁷ M⁻¹. PRES classically consists of reversiblevasogenic edema in the posterior circulation territories, however,conversion to irreversible cytoxic edema has been described. PRES istypically characterized by headache, nausea, vomiting, confusion,seizures, visual abnormalities, altered mental functioning, ataxia,frontal symptoms, parietal symptoms, stupor, and focal neurologic signs.In addition to the foregoing clinical symptoms, MRI scans or FluidAttenuated Inversion Recovery (FLAIR) sequence imaging can be used toindicate the presence on PRES. (See Pediatric Neurology, 20(3):241-243;AJNR, 26:825-830; NEJM, 334(8):494-500; Pediatr Nephrol, 18:1161-1166;Internal Medicine Journal, 35:83-90; JNNP, 68:790-791; AJNR,23:1038-1048; Pak J Med Sci, 21(2):149-154 and, AJNR, 21:1199-1209.)

Patients may be monitored for PRES or vascular edema monthly, every fourmonths, every six months, or yearly. The patient may be monitored for atleast one clinical symptom associated with PRES or vascular edema. Themonitoring may comprise performing an MRI scan. The monitoring mayfurther comprise performing FLAIR sequence imaging. The results of themonitoring may impact the dosing regime. For example, if PRES orvascular edema is detected, dosing may be suspended or dosages may bereduced or the intervals between dosages may be increased.

Patients with PRES or vascular edema may have their blood pressuremeasured for hypertension. If hypertension is detected in the patient,the patient may be treated for the hypertension by administration of anantihypertensive. The antihypertensive may be selected from the groupconsisting of hydroclorothiazide, angiotensin-converting enzyme (ACE)inhibitors, angiotensin II-receptor blockers (ARB), beta blockers, andcalcium channel blockers. Patient with PRES or vascular edema may betreated with steroids such as dexamethasone or methyprednisol.

C. Kits

The invention further provides therapeutic products. The productscomprise a glass vial and instructions. The glass vial contains aformulation comprising about 10 mg to about 250 mg of a humanized antiAβ antibody, about 4% mannitol or about 150 mM NaCl, about 5 mM to about10 mM histidine, and about 10 mM methionine. The instructions to monitora patient to whom the formulation is administered for PRES and orvascular edema are included with the products. In some therapeuticproducts the glass vial contains a formulation comprising about 10 mg ofa humanized anti Aβ antibody in about 10 mM histidine, about 10 mMmethionine, about 4% mannitol, and about 0.005% polysorbate-80(vegetable derived), with a pH of about 6.0. The instructions to monitora patient to whom the formulation is administered for PRES or vascularedema are included with the products.

EXAMPLE I Prevention and Treatment of Human Subjects

Bapineuzumab (AAB-001) is a humanized monoclonal antibody to Aβ. Theobjective of this study is to determine the safety and tolerability ofsingle doses of bapineuzumab in AD.

Methods: Randomized, double-blind, placebo-controlled single ascendingdose trial of bapineuzumab infusion in patients with mild to moderateAD. Patients enrolled in the trial met all of the following criteria:

-   -   1. Diagnosis of probable Alzheimer's disease (AD) according to        the National Institute of Neurological and Communicative        Disorders and Stroke-Alzheimer's disease and Related Disorders        (NINCDS-ADRDA) criteria.    -   2. Age from 50 to 87 years, inclusive.    -   3. Mini-Mental Status Examination (MMSE) score of 14-26.    -   4. Rosen Modified Hachinski Ischemic score≦4.    -   5. Lives at home with appropriate caregiver capable of        accompanying the patient on all clinic visits, or community        dwelling with caregiver capable of accompanying the patient on        all clinic visits and visiting with the patient approximately 5        times per week for the duration of the study.    -   6. Screening visit brain magnetic resonance imaging (MRI) scan        consistent with the diagnosis of AD, i.e., that there are no        other abnormalities present on the MRI that can be attributed to        other diseases (e.g., stroke, traumatic brain injury, arachnoid        cysts, tumors, etc).    -   7. Surgically sterile or 2 years post-menopausal.    -   8. Fluent in English and evidences adequate premorbid        intellectual functioning. Patient must have adequate visual and        auditory abilities to perform all aspects of the cognitive and        functional assessments.    -   9. Receiving stable doses of medication(s) for the treatment of        non-excluded medical condition(s) for at least 30 days prior to        screening. If a patient is taking acetylcholinesterase        inhibitors or memantine, then these medication(s) must be        maintained on a stable dose regimen for at least 60 days prior        to screening evaluations.

Anyone of the following criteria excluded a patient from being enrolledin the trial:

-   -   1. Significant neurological disease, other than AD, that may        affect cognition.    -   2. Current presence of a clinically significant major        psychiatric disorder (e.g., major Depressive Disorder) according        to the criteria of the Diagnostic and Statistical Manual of        Mental Disorders, Fourth Edition (DSM-IV), or symptom (e.g.,        hallucinations), that could affect the patient's ability to        complete the study.    -   3. Current clinically significant systemic illness that is        likely to result in deterioration of the patient's condition or        affect the patient's safety during the study.    -   4. History or evidence of any of the following: encephalitis;        clinically evident stroke; clinically significant carotid or        vertebrobasilar stenosis or plaque; seizures, excluding febrile        seizures in childhood; any clinically significant autoimmune        disease or disorder of the immune system; clinically significant        renal disorder.    -   5. Clinically significant infection with the last 30 days (e.g.,        chronic persistent or acute infection).    -   6. Treatment with immunosuppressive medications (e.g., systemic        corticosteroids) within the last 90 days (topical and nasal        corticosteroids and inhaled corticosteroids for asthma are        permitted) or chemotherapeutic agents for malignancy within the        last 3 years.    -   7. Myocardial infarction within the last 2 years.    -   8. History of cancer within the last 5 years, with the exception        of non-metastatic basal cell carcinoma and squamous cell        carcinoma of the skin.    -   9. Other clinically significant abnormality on physical,        neurological, laboratory, or ECG examination (e.g., atrial        fibrillation) that could compromise the study or be detrimental        to the patient.    -   10. Hemoglobin less than 11 g/dL.    -   11. History of alcohol or drug dependence or abuse within the        last 2 years.    -   12. Hamilton Psychiatric Rating Scale for Depression (HAM-D)        (17-item) score>12.    -   13. Current use of anticonvulsants for seizure,        anti-Parkinson's, anticoagulant (excluding the use of aspirin        325 mg/day or less), or narcotic medications.    -   14. Current use of prescription or nonprescription medication        for cognitive enhancement other than cholinesterase inhibitors        and memantine. Current cholinesterase inhibitor and memantine        use is prohibited unless the following conditions are met: (a)        maintained on a stable dose regimen for at least 60 days prior        to screening; (b) patient is free of any clinically significant        side effects attributable to the drug; and (c) patient and        caregiver agree that, barring unforeseen circumstances, they        will continue the same regimen for the duration of the trial.    -   15. Unless maintained on a stable dose regimen for at least 30        days prior to screening, any other medications with the        potential to affect cognition other than those mentioned in #18        (including, but not limited to, anxiolytics, sedatives,        hypnotics, antipsychotics, antidepressants, over-the-counter        (OTC) sleeping aids, sedating anti-allergy medications, vitamin        E, thyroid supplements, and vitamin B12 supplements by        injection).    -   16. Patients who have discontinued cholinesterase inhibitors,        memantine, cognitive enhancing agents, or drugs that potentially        affect cognition in the 60 days prior to screening.    -   17. Use of an experimental medication (chemical compound) or        device for AD or any other investigational medication or device        for indication other than treatment for AD within 30 days prior        to screening or within 5 half-lives of use of such a medication        prior to screening, whichever is longer.    -   18. Any prior experimental treatment with AN1792, AAB-001,        ACC-001, or other experimental immunotherapeutic or vaccine for        AD.    -   19. Any prior treatment with a biologic product other than those        mentioned in #18 for the treatment of AD within the last 3        years.    -   20. Patients who have donated blood (routine blood donation) in        the 90 days prior to screening.    -   21. Any known hypersensitivity to any of the excipients        contained in the study drug formulation.    -   22. Presence of pacemakers, aneurysm clips, artificial heart        valves, ear implants, metal fragments of foreign objects in the        eyes, skin, or body that would contraindicate a brain MRI scan.    -   23. Weight greater than 120 kg (264 lbs).

Results: 30 patients received bapineuzumab at doses of 0.5 mg/kg (6active, 2 placebo) 1.5 mg/kg (6 active, 2 placebo) and 5 mg/kg (10active, 4 placebo). 3/10 patients at 5 mg/kg developed MRIabnormalities, consisting predominantly of high signal abnormalities onFLAIR sequences, and the study did not continue past that dose. In twopatients these were seen on routine surveillance scans without clinicalsymptoms, however a third patient experienced increased confusion. TheMRI FLAIR abnormalities resolved in all three cases by 12 weekspost-dose. As part of the safety assessments MMSE was performed atbaseline, week 4, week 16, 6 months and at 1 year. FIG. 2 shows theaverage MMSE change from baseline. FIG. 3 shows the change from baselineMMSE by cohort at month 4. At week 16, the prespecified primary timepoint for analysis, the treatment difference relative to placebo favoredthe treated group at the 0.5 mg/kg dose (treatment vs. placebodifference of 2.0, p=0.152) and reached statistical significance at the1.5 mg/kg dose (treatment vs. placebo difference of 2.5, p=0.047). Therewas no significant difference in MMSE change relative to placebo for the5.0 mg/kg group. FIG. 4 shows the mean, median and standard deviationMMSE change from baseline at month four. FIG. 5 shows the results ofstatistical testing of the MMSE change from baseline at month four. Nocorrelation was found between the MRI FLAIR abnormalities and thedifference in MMSE change.

Plasma A-beta was elevated from baseline levels in a dose dependentfashion, peaking approximately 24 hours after the infusion.Pharmacokinetic analysis showed a half life of 22-28 days and wassupportive of a 13-week dosing interval in multiple dosing.

Conclusion: In this small study, MMSE was statistically significantlyimproved compared with placebo at the 1.5 mg/kg dose of bapineuzumab.The highest single infusion dose of 5 mg/kg was associated with MRIFLAIR abnormalities which resolved.

Although the foregoing invention has been described in detail forpurposes of clarity of understanding, it will be obvious that certainmodifications may be practiced within the scope of the appended claims.All publications and patent documents cited herein, as well as textappearing in the figures, are hereby incorporated by reference in theirentirety for all purposes to the same extent as if each were soindividually denoted.

EXAMPLE II Pharmacokinetic Study of AAB-001

The objective of this study is to determine human pharmacokinetics (PK)after intravenous administration of AAB-001.

Methods: Randomized, double-blind, placebo-controlled multiple ascendingdose trial of AAB-001 administered intravenously. 6 doses of AAB-001were administered intravenously q13 wk. There were four dose cohortswere 0.15, 0.5, 1.0 and 2.0 mg/kg.

Results: PK was predictable and dose-independent. PK-CL 0.05-0.06mL/h/kg across all dose levels. Dose-proportional exposure. Very littleaccumulation with q13 wk IV dosing, although quantifiable pre-infusionconcentrations at all dose levels. t½ ranged from 21-34 hours. Atsteady-state, Cavg after 0.5 mg/kg AAB-001 (i.e., ˜35 mg) ˜3.3 μg/mL.See FIG. 9. Cavg after 0.5 mg/kg AAB-001 of ˜3.3 μg/mL is close to the3.7 μg/mL concentration found to be efficacious in PDAPP mice. FIG. 10shows mean serum AAB-001 concentration vs. time profiles followingintravenous administration of AAB-001 at doses of 0.15, 0.5, 1.0, and2.0 mg/kg.

Plasma Aβ concentrations tend to mirror AAB-001 concentrations. At endof 13-week dosing interval, plasma Aβ levels above baseline levels andabove placebo group at ≧0.5 mg/kg AAB-001 dose levels. See FIG. 11. tmaxranged from 14-48 hours.

Serum anti-AAB-001 antibody levels have been undetectable in any of thesamples (up to pre-Infusion #6 for the 0.5 mg/kg AAB-001 cohort).

From the foregoing it will be apparent that the invention provides for anumber of uses. For example, the invention provides for the use of anyof the antibodies to Aβ described above in the treatment, prophylaxis ordiagnosis of amyloidogenic disease, or in the manufacture of amedicament or diagnostic composition for use in the same.

We claim:
 1. A method of therapeutically treating Alzheimer's disease,comprising administering by intravenous infusion to a human patientsuffering from the disease a dosage of an antibody that specificallybinds to an N-terminal fragment of beta-amyloid peptide (Aβ) with abinding affinity of at least 10⁷ M⁻¹, and monitoring the patient forposterior reversible encephalopathy syndrome (PRES) or vascular edema,wherein the method comprises the steps of: (a) administering a firstdosage to the patient; (b) monitoring the patient and detecting thepresence of PRES or vascular edema at a first time point; (c) optionallyadministering a second dosage to the patient after the monitoring instep (b) detects presence of PRES or vascular edema; (d) monitoring thepatient and detecting the absence of PRES or vascular edema at a secondtime point; and (e) administering another dosage to the patient afterthe monitoring in step (d) indicates absence of PRES or vascular edema,wherein the dosages in (a) and (e) are higher than the dosage in (c) ifa dosage is administered in (c).
 2. A method of therapeutically treatingAlzheimer's disease, comprising administering by intravenous infusion toa human patient suffering from the disease a dosage of an antibodywithin a range of about 0.5 mg/kg to less than 5 mg/kg, wherein theantibody specifically binds to an N-terminal fragment of beta-amyloidpeptide (Aβ) with a binding affinity of at least 10⁷ M⁻¹, and monitoringthe patient for posterior reversible encephalopathy syndrome (PRES) orvascular edema, wherein the method comprises the steps of: (a)administering a first dosage to the patient; (b) monitoring the patientand detecting the presence of PRES or vascular edema at a first timepoint; (c) optionally administering a second dosage to the patient afterthe monitoring in step (b) detects presence of PRES or vascular edema;(d) monitoring the patient and detecting the absence of PRES or vascularedema at a second time point; and (e) administering another dosage tothe patient after the monitoring in step (d) indicates absence of PRESor vascular edema, wherein the dosages in (a) and (e) are higher thanthe dosage in (c) if a dosage is administered in (c).
 3. The method ofclaim 1 or 2, wherein the antibody is a humanized antibody.
 4. Themethod of claim 3, wherein the humanized antibody is a humanized versionof mouse antibody 3D6 expressed by the hybridoma deposited under ATCCunder No. PTA-5130.
 5. The method of claim 4, wherein the humanizedantibody is bapineuzumab.
 6. The method of claim 5, wherein the firstdosage is 3-5 mg/kg and the second dosage is 0.5 to 3 mg/kg.
 7. Themethod of claim 6, wherein the second dosage is half of the firstdosage.
 8. The method of claim 1 or 2, wherein the dosages areadministered every 8 to 16 weeks.
 9. The method of claim 8, wherein thedosages are administered every 10 to 14 weeks.
 10. The method of claim9, wherein the dosages are administered every 13 weeks.
 11. The methodof claim 1 or 2, wherein the first and third dosages are the same. 12.The method of claim 1 or 2, wherein the first dosage is 3-5 mg/kg andthe second dosage is 0.5 to 3 mg/kg.
 13. The method of claim 12, whereinthe second dosage is half of the first dosage.
 14. The method of claim 1or 2, wherein the monitoring comprises performing an MRI scan.
 15. Themethod of claim 14, wherein the monitoring further comprises performinga FLAIR (Fluid Attenuated Inversion Recovery) sequence imaging.
 16. Themethod of claim 15, further comprising reducing or suspending the seconddosage based on an outcome of the FLAIR sequence imaging that isindicative of PRES or vascular edema.
 17. The method of claim 14,wherein the MRI scan is every 3 months, every 6 months, or every year.18. The method of claim 15, wherein the FLAIR sequence imaging is every3 months, every 6 months, or every year.
 19. The method of claim 14,wherein the monitoring comprises identifying of at least one clinicalsymptom associated with PRES or vascular edema.
 20. The method of claim19, wherein the at least one clinical symptom is selected from the groupconsisting of headache, nausea, vomiting, confusion, seizures, visualabnormalities, altered mental functioning, ataxia, frontal symptoms,parietal symptoms, stupor, and focal neurologic signs.
 21. The method ofclaim 20, further comprising reducing or suspending the second dosagebased on an identification of at least one clinical symptom associatedwith PRES or vascular edema.
 22. The method of claim 14, furthercomprising reducing or suspending the second dosage based on an outcomeof the MRI scan that is indicative of PRES or vascular edema.
 23. Themethod of claim 22, further comprising determining presence or absenceof hypertension in the patient, wherein if the patient has hypertension,the method further comprises administering an antihypertensive.
 24. Themethod of claim 23, wherein the antihypertensive is selected from thegroup consisting of hydroclorothiazide, angiotensin-converting enzyme(ACE) inhibitors, angiotensin II-receptor blockers (ARB), beta blockers,and calcium channel blockers.
 25. The method of claim 22, wherein themethod further comprises administering a steroid to the patient to treatthe PRES or vascular edema.
 26. The method of claim 25, wherein thesteroid is dexamethasone.
 27. The method of claim 25, wherein thesteroid is methyprednisolone.
 28. The method of claim 1 or 2, furthercomprising monitoring the patient by at least one type of assessmentselected from the group of consisting of Mini-Mental State Exam (MMSE),Alzheimer's Disease Assessment Scale-cognitive (ADAS-COG), ClinicianInterview-Based Impression (CIBI), Neurological Test Battery (NTB),Disability Assessment for Dementia (DAD), Clinical Dementia Rating-sumof boxes (CDR-SOB), Neuropsychiatric Inventory (NPI), Positron EmissionTomography (PET Imaging) scan, Magnetic Resonance Imaging (MRI) scan,EKG and measurement of blood pressure.
 29. The method of claim 28,wherein the assessment type is an Alzheimer's Disease AssessmentScale-cognitive (ADAS-COG).
 30. The method of claim 29, wherein theADAS-COG is administered on multiple occasions.
 31. The method of claim28, wherein the assessment type is a Neurological Test Battery (NTB).32. The method of claim 31, wherein the NTB is administered on multipleoccasions.
 33. The method of claim 28, wherein the type of assessment isan MMSE.
 34. The method of claim 33, wherein the MMSE is administered onmultiple occasions.
 35. The method of claim 34, wherein the MMSE isperformed before administering the first dosage, and at week 4, week 16,6 months, and 1 year after administering the first dosage.
 36. Themethod of claim 34, wherein the MMSE score measured after administrationis higher than a previously assessed MMSE score.